Bladder trauma

[PussyCat]

External bladder injuries are caused by either blunt or penetrating trauma to the lower abdomen, pelvis, or perineum. Blunt trauma is the more common mechanism, usually by a sudden deceleration, such as in a high-speed motor vehicle crash or fall, or from an external blow to the lower abdomen. The most frequently accompanying injury is a pelvic fracture, occurring in gt; 95% of bladder ruptures caused by blunt trauma. Other concomitant injuries include long bone fractures and central nervous system and chest injuries. Penetrating injuries, most often gunshot wounds, account for lt; 10% of bladder injuries.
The bladder is the most frequently injured organ during pelvic surgery. Such injuries can occur during transurethral surgery, gynecologic procedures (most commonly abdominal hysterectomy, cesarean section, pelvic mass excision), or colon resection. Predisposing factors include scarring from prior surgery or radiation therapy, inflammation, and extensive tumor burden.
Bladder injuries are classified as contusions or ruptures based on the extent of injury seen radiographically. Ruptures can be extraperitoneal, intraperitoneal, or both; most are extraperitoneal.
Complications of bladder injuries include urinary ascites (free urine in the peritoneal cavity) due to intraperitoneal rupture, infection (including sepsis), persistent hematuria, incontinence, bladder instability, and fistula. Mortality with bladder rupture from external trauma can approach 20%; this is due to concomitant organ injuries rather than the bladder injury.