Role of Ultrasonography in Intraperitoneal Bladder Rupture With Delayed Presentation

Abstract

Delayed presentation of intraperitoneal rupture of the urinary bladder in a child after blunt trauma is a rare occurrence. On ultrasonography, diagnosis of bladder injuries has been sparsely reported in the literature. We report a case of intraperitoneal bladder rupture in a four-year-old child and describe the role of ultrasonography in providing a prompt and accurate diagnosis of the entity as mortality increases if surgical repair is delayed. On high-resolution ultrasonography, rent was noted in the urinary bladder dome with fluid collection in the paracolic gutters and between loops of the small bowel. Peritoneocentesis demonstrated urine and the child was taken up for laparoscopic repair of the bladder tear, which was visualized at the bladder dome. Cystogram performed at one week was unremarkable and the post-operative period was uneventful with no complaints at a one-month follow-up.

Delayed Iatrogenic Bladder Rupture Diagnosed by POCUS in the Emergency Department

“…Interestingly, these values did not differ greatly between hypotensive and normotensive patients. Abdominal free fluid was also reported in all traumatic and atraumatic case reports of intraperitoneal bladder rupture evaluated with radiologist- or technician-performed ultrasound 14 , 21 , 22 , 23 , 25 , 26 , 27 . Similarly, our case showed large volume of free fluid in Morison’s pouch and the rectovesical pouch with the patient reclined in Trendelenburg position, which increases sensitivity for free fluid 28 .…”

“…Most prior cases of bladder rupture diagnosed by ultrasound occurred in the setting of trauma using the Focused Assessment with Sonography for Trauma (FAST) examination 21 , 22 , 23 . A 2019 systematic review and meta-analysis reported that POCUS was 74% sensitive and 98% specific for intra-abdominal free fluid in trauma 24 .…”

“…Intraperitoneal bladder ruptures most commonly occur at the bladder dome, the weakest and most mobile part of the bladder 2 . In one blunt trauma case, POCUS was used to identify the precise site of rupture at the bladder dome, leading directly to peritoneal free fluid 23 . In our case, POCUS similarly identified a purported site of bladder rupture.…”