A 24-year-old man develops gross haematuria and suprapubic pain after a seat belt injury. He has a full bladder and no pelvic fracture. Cystography shows contrast outlining loops of bowel within the peritoneal cavity. The next step is:
- A Conservative management with catheter drainage alone
- B Immediate exploratory laparotomy with repair of the bladder ✓
- C CT urogram and discharge if stable
- D Percutaneous suprapubic catheter placement only
Correct answer: B. Immediate exploratory laparotomy with repair of the bladder
Explanation
Contrast flowing freely around bowel loops confirms an intraperitoneal bladder rupture, typical when a full bladder is compressed by a seat belt or steering wheel without pelvic fracture. Because urine contaminates the peritoneal cavity, these injuries require operative exploration, closure of the dome defect in layers, and catheter drainage. Extraperitoneal ruptures, by contrast, are managed conservatively with urethral or suprapubic catheter drainage for about 10 days unless there is associated bladder neck or rectal injury.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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