Bladder Trauma
Bladder rupture is diagnosed by CT cystography and split into extraperitoneal (usually catheter drainage) versus intraperitoneal (needs surgical repair) — the distinction that decides management.
The big picture
The bladder is injured mainly by blunt pelvic trauma. Extraperitoneal rupture is strongly associated with pelvic fractures (bony spicules/shearing) and leaks into the perivesical space; intraperitoneal rupture results from a burst of a full bladder (a blow to a distended bladder) and spills urine into the peritoneal cavity, often causing urinary ascites and a rising creatinine from peritoneal reabsorption.
CT cystogram with adequate distension makes the diagnosis; extraperitoneal rupture is drained, intraperitoneal rupture is repaired.
Mechanism pathway
Tap any step to see why it happens.
Diagnostic algorithm
Each step answers one question. Tap to expand.
Treatment ladder
Manage by rupture type: drain extraperitoneal injuries, repair intraperitoneal ones, and repair complicated/combined injuries.
Drug selector
Extraperitoneal rupture
Pelvic fracture + flame-shaped perivesical leak = extraperitoneal → drain.- Targets
- Leak confined to the perivesical space; strongly associated with pelvic fractures.
- Onset
- See detail
- Use when
- Most heal with drainage.
- Side effects
- Catheter drainage (operate if bladder neck involved, bone fragment in wall, or concomitant surgery).
Procedure chooser
- Intraperitoneal rupture: surgical repair (multi-layer closure)
- Extraperitoneal exceptions needing repair: bladder-neck involvement, bone fragment in the bladder wall, rectal/vaginal injury, or laparotomy for other reasons (often repaired concurrently)
Complications
- Urinary ascites/peritonitis (intraperitoneal)
- Urinoma, abscess, fistula
- Sepsis
- Catheter blockage
- Wound/repair leak or infection
- Correctly classify and treat by type
- Ensure adequate drainage; follow-up cystogram before removal
- Repair persistent leaks
- Drain collections
Follow-up
- Healing on follow-up cystogram
- Resolution of haematuria
- Urinary continence/function
- Follow-up cystogram (typically ~1–2 weeks) before removing the catheter
- No leak on follow-up cystogram; bladder heals
- Persistent leak, urinoma, fistula
- Before catheter removal; if symptoms persist
- Fistula, stricture (rare), persistent leak if mismanaged
If treatment fails
If an extraperitoneal injury fails to heal on drainage, ask: is the catheter draining adequately, or is there an exception (bladder-neck/bone fragment) requiring repair?
Red flags
It will not heal — intraperitoneal rupture needs surgical repair.
Exclude a urethral injury (RUG) before catheterising.
Intraperitoneal urine reabsorption — suspect intraperitoneal bladder rupture.
Summary tables
Extraperitoneal vs intraperitoneal rupture
| Feature | Extraperitoneal | Intraperitoneal |
|---|---|---|
| Typical mechanism | Pelvic fracture | Blow to a full bladder |
| Leak location | Perivesical space | Peritoneal cavity (urinary ascites) |
| Default treatment | Catheter drainage | Surgical repair |
| Confirm healing | Follow-up cystogram | Follow-up cystogram |
Memory hooks
CT cystogram — fill the bladder, don't under-distend.
Extraperitoneal → drain.
Intraperitoneal → repair.
Pelvic fracture ↔ extraperitoneal; burst full bladder ↔ intraperitoneal.
Follow-up cystogram before pulling the catheter.
Board traps
Intraperitoneal rupture 'managed' with drainage — wrong, it needs repair.
Missed rupture because the cystogram bladder was not distended.
Extraperitoneal rupture with bladder-neck involvement left to drain instead of repaired.
Clinical cases
After a road traffic collision a patient has gross haematuria and cannot void. A urethral injury is excluded. CT cystography shows contrast outlining loops of bowel within the peritoneal cavity.
What is the rupture type and the correct treatment?