Following blunt pelvic trauma, CT cystography shows contrast instilled via Foley catheter escaping from the bladder dome and outlining loops of small bowel within the peritoneal cavity. Which statement is correct?

• A This is an extraperitoneal rupture, managed conservatively with catheter drainage alone
• B This pattern occurs only with penetrating trauma and never with blunt trauma
• C Contrast around bowel loops indicates a urethral injury, so cystography should be abandoned
• D This is an intraperitoneal rupture, typically requiring operative repair ✓

Explanation

Intraperitoneal bladder rupture follows a blow to a distended bladder and usually tears the dome, the least supported part. On CT cystography, contrast escapes through the dome defect and flows freely between bowel loops and into the paracolic gutters, a distribution impossible in extraperitoneal rupture where contrast stays confined around the bladder base in a molar tooth pattern. Because urine enters the peritoneum causing chemical peritonitis, intraperitoneal rupture generally requires surgical repair rather than catheter drainage alone.

Reference: Grainger and Allison's Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.