A 30-year-old man presents after a fall from height with lower abdominal pain and inability to void. There is no pelvic fracture. Retrograde cystography shows contrast extravasating freely into the peritoneal cavity, outlining loops of bowel. What is the definitive management?

• A Suprapubic catheter drainage alone
• B Urethral catheter drainage alone
• C Surgical exploration with two-layer closure of the bladder ✓
• D Percutaneous pigtail drainage of the extravasated urine

Explanation

Intraperitoneal bladder rupture, typically from a full bladder struck by direct force, always requires surgical exploration and formal two-layer closure because urine entering the peritoneum causes chemical peritonitis and will not heal with drainage alone. Extraperitoneal ruptures, usually associated with pelvic fractures, are managed conservatively with urethral catheter drainage. The cystogram outlining bowel loops confirms the intraperitoneal type here.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.