A 35-year-old man involved in a motorcycle crash has gross haematuria and suprapubic pain. CT cystography reveals contrast extravasating freely into the peritoneal cavity and outlining loops of bowel. What is the appropriate management?
- A Surgical exploration and repair of the bladder ✓
- B Percutaneous suprapubic catheterisation alone
- C Two weeks of urethral catheter drainage alone
- D Nephrostomy drainage of both kidneys
Correct answer: A. Surgical exploration and repair of the bladder
Explanation
Contrast outlining bowel loops confirms an intraperitoneal bladder rupture, caused by a burst injury of the dome in a full bladder. Urine entering the peritoneum causes chemical peritonitis, so operative repair with omental coverage of the suture line is required. Catheter drainage alone is adequate for extraperitoneal ruptures, which show flame shaped peri-vesical contrast rather than intraperitoneal contrast.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.