High rising flames: a sign of complex extraperitoneal bladder rupture

Area of Science:

• Urology
• Radiology
• Trauma Surgery

Background:

• Extraperitoneal bladder rupture is common after pelvic trauma, typically showing contained contrast extravasation on CT cystography.
• The usual appearance is flame-shaped, confined to the perivesical space.
• Extravasation can extend to adjacent areas like the scrotum or abdominal wall.

Observation:

• This case presents a complex extraperitoneal bladder rupture associated with pelvic fracture and urethral distraction defect.
• Unusual CT cystogram findings were observed.
• Large-volume contrast extravasation extended significantly beyond the perivesical space.

Findings:

• The contrast extravasation extended into the left perinephric region.
• The pattern resembled high rising flames, deviating from the typical flame-shaped appearance.
• This indicates a more extensive injury than commonly seen.

Implications:

• Highlights the importance of detailed CT cystography interpretation in pelvic trauma.
• Suggests that complex bladder ruptures can have unusual and extensive extravasation patterns.
• May influence surgical planning and management of severe pelvic and bladder injuries.