Not Available
Society for Pediatric Radiology – Poster Archive
Final ID: Poster #: CR-014
8 Year Old Girl with Lower Urinary Tract and Pelvic Floor Injuries - When an Extraperitoneal Bladder Rupture Requires Emergent Intervention
Purpose or Case Report:
Urinary bladder injuries are classified based on intraperitoneal versus extraperitoneal location. Intraperitoneal lacerations are associated with a higher risk of sepsis and tend to be large and are therefore treated with prompt surgical exploration and repair. In contrast, extraperitoneal bladder ruptures are commonly managed conservatively via simple catheter drainage with healing commonly achieved between 10 days and 3 weeks. However, lower urinary tract injuries are an exception to the rule which also require emergent intervention.
The subject of this case report is an 8-year old girl that suffered lacerations to the bladder neck, bladder trigone, and pelvic floor during a motor vehicle collision. The initial contrast-enhanced phase demonstrated bladder wall thickening and intraluminal blood clot. Bladder rupture was not directly apparent until the patient was called back for a delayed scan of the pelvis which showed contrast extravasation from the trigone pooling around retroperitoneal spaces including the mesorectal fascia surrounding the rectum and the presacral space. Although these are not intraperitoneal locations, the radiologist should be aware that lacerations involving the bladder neck and lower urinary tract warrant immediate surgical consultation.
Lower urinary tract injuries are sufficiently uncommon that an experienced urologist may encounter only a handful during their career. This case report highlights the anatomic spaces in the pelvis that are necessary to troubleshoot the likely location of a bladder injury and that the lack of intraperitoneal pooling of contrast should not distract from the emergent nature of this rare injury. The common association of lower urinary tract injury with pelvic floor disruption is also highlighted in this case as the patient had lacerations and pooling of contrast extending along the vagina and into the labia. Finally, the importance of delayed excretory phase imaging in the setting of pelvic trauma is emphasized to allow for the prompt diagnosis of bladder trauma.
Methods & Materials:
Results:
Conclusions:
Urinary bladder injuries are classified based on intraperitoneal versus extraperitoneal location. Intraperitoneal lacerations are associated with a higher risk of sepsis and tend to be large and are therefore treated with prompt surgical exploration and repair. In contrast, extraperitoneal bladder ruptures are commonly managed conservatively via simple catheter drainage with healing commonly achieved between 10 days and 3 weeks. However, lower urinary tract injuries are an exception to the rule which also require emergent intervention.
The subject of this case report is an 8-year old girl that suffered lacerations to the bladder neck, bladder trigone, and pelvic floor during a motor vehicle collision. The initial contrast-enhanced phase demonstrated bladder wall thickening and intraluminal blood clot. Bladder rupture was not directly apparent until the patient was called back for a delayed scan of the pelvis which showed contrast extravasation from the trigone pooling around retroperitoneal spaces including the mesorectal fascia surrounding the rectum and the presacral space. Although these are not intraperitoneal locations, the radiologist should be aware that lacerations involving the bladder neck and lower urinary tract warrant immediate surgical consultation.
Lower urinary tract injuries are sufficiently uncommon that an experienced urologist may encounter only a handful during their career. This case report highlights the anatomic spaces in the pelvis that are necessary to troubleshoot the likely location of a bladder injury and that the lack of intraperitoneal pooling of contrast should not distract from the emergent nature of this rare injury. The common association of lower urinary tract injury with pelvic floor disruption is also highlighted in this case as the patient had lacerations and pooling of contrast extending along the vagina and into the labia. Finally, the importance of delayed excretory phase imaging in the setting of pelvic trauma is emphasized to allow for the prompt diagnosis of bladder trauma.
Methods & Materials:
Results:
Conclusions:
More abstracts on this topic:
Nonaccidental Brain Trauma: From Fetus to Newborn
Salinas Puente Estefany, Blanqueto Fuentes David, Rodríguez Garza Claudia, Dávila Escamilla Ivan, Montemayor Martínez Alberto
Pediatric Urinary Bladder Masses and Pseudo-masses: A Pictorial Review with Emphasis on Ultrasound FindingsGokli Ami, Barrera Christian, Bellah Richard
Poster____CR-014.pdf
Comments
We encourage you to join the discussion by posting your comments and questions below.
Presenters will be notified of your post so that they can respond as appropriate.
This discussion platform is provided to foster engagement, and stimulate conversation and knowledge sharing.
Please click here to review the full terms and conditions for engaging in the discussion, including refraining from product promotion and non-constructive feedback.
You have to be authorized to post a comment. Please,
Login or
Signup.
Please note that this is a separate login, not connected with your credentials used for the SPR main website.
Rate this abstract
(Maximum characters: 500)
Please note that this is a separate login, not connected with your credentials used for the SPR main website.