Pediatric Bladder Trauma

Etiology:
— Blunt abdominal trauma leading to increased bladder pressure
— Bladder surgery
Imaging CT: See extravasated urinary contrast with intraperitoneal rupture into peritoneum or extraperitoneal rupture into peri-vesical and pre-vesical spaces
— Note: When performing CT cystogram obtain images first with bladder filled with diluted water soluble contrast and then after bladder has been emptied
DDX:
Complications: Intraperitoneal absorption of large amounts of urine leads to electrolyte and metabolic abnormalities
Treatment:
— Extraperitoneal bladder rupture treated with catheterization
— Intraperitoneal bladder rupture treated with intraoperative repair because absorption of large amounts of urine leads to electrolyte and metabolic abnormalities
Clinical:
— In less than 1% of blunt trauma patients
— Usually associated with pelvic fracture or lap belt ecchymoses
— Extraperitoneal bladder rupture more common than intraperitoneal bladder rupture

Radiology Cases of Bladder Trauma

Radiology Cases of Incorrect CT Technique Without the Use of Intravenous Contrast for the Assessment of Blunt Abdominal Trauma

CT without intravenous contrast using incorrect technique for the assessment of blunt abdominal trauma — Axial CT without contrast of the abdomen shows grossly unremarkable unenhanced solid organs of the abdomen without free air or free fluid.

Radiology Cases of Intraperitoneal Bladder Rupture

VCUG of intraperitoneal bladder rupture — Lateral image from a voiding cystourethrogram during bladder filling (left) shows extravasation of contrast out of the base of the bladder into the peritoneum. AXR AP obtained after the exam (right) shows intraperitoneal contrast outlining the liver, spleen, and centralized loops of bowel.

Radiology Cases of Extraperitoneal Bladder Rupture

CT of bladder trauma / bladder perforation — Axial CT with contrast of the abdomen shows bilateral pubic rami fracture (above) with a Foley catheter in the center of the bladder and contrast extravasating out of the bladder into the perivesical space (below).

VCUG of extraperitoneal bladder leak — AP image from a voiding cystourethrogram shows contrast leaking out of the right side of the bladder into an extraperitoneal location.

Radiology Cases of Extraperitoneal Bladder Trauma and Vaginal Trauma and Rectal Trauma

CT of pediatric vaginal trauma and extraperitoneal bladder rupture — Immediate contiguous (above) sagittal CT with contrast of the pelvis shows on the immediate image fluid and air anterior to the bladder (above left) and air anteriorly in the fluid-filled vagina and active bleeding in the rectum posteriorly (above right). The delayed image (below) shows extravasated intravenous contrast anterior to the contrast filled bladder.