A 25-year-old man involved in a motor vehicle accident presents with lower abdominal pain and difficulty voiding after drinking several beers. CT cystography demonstrates contrast leaking freely into the peritoneal cavity and outlining loops of bowel. What is the definitive management?

• A Two weeks of closed catheter drainage alone
• B Repeat cystography in 48 hours
• C Percutaneous suprapubic drainage alone
• D Open surgical repair of the bladder with closure of the perforation ✓

Explanation

Contrast outlining bowel loops within the peritoneal cavity establishes an intraperitoneal bladder rupture, which occurs when a full bladder is compressed against the sacral promontory and ruptures at the dome. Unlike most extraperitoneal ruptures, which can be managed with catheter drainage alone, intraperitoneal rupture requires operative exploration and direct suturing of the defect, because urine contaminating the peritoneum causes chemical peritonitis. Catheter drainage alone leaves a persistent leak into the abdomen.

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.