Related Experiment Video
Updated: Jun 6, 2025
Detrusor Underactivity Model in Rats by Conus Medullaris Transection
Published on: August 28, 2020
Delayed diagnosis of pediatric bladder rupture with atypical presentation after a minor fall
Graham Aufricht1, Christopher J Yen2, Andrew J Kienstra1
1The University of Texas at Austin Dell Medicine, Department of Pediatrics, Austin, TX, United States of America; US Acute Care Solutions, United States of America.
Insights
Delayed intraperitoneal bladder rupture in children can occur after minor trauma. Emergency physicians should suspect this rare diagnosis in pediatric patients with unexplained abdominal issues, even without severe injury signs.
Area of Science:
- Pediatric Urology
- Trauma Surgery
- Emergency Medicine
Background:
- Pediatric bladder injuries are uncommon, often resulting from blunt trauma, with intraperitoneal ruptures being rarer but more prevalent in children due to anatomical differences.
- This case highlights a delayed intraperitoneal bladder rupture in a young child following a minor fall, underscoring diagnostic challenges.
Observation:
- A 4-year-old female presented with abdominal pain, vomiting, and fever three days post-fall, showing abdominal tenderness, elevated creatinine, and ascites on ultrasound.
- Initial treatment for acute kidney injury was ineffective, prompting further investigation.
Findings:
- Cystography revealed a large posterior dome bladder rupture, a rare finding in pediatric patients after minor trauma.
- Surgical repair led to a full recovery, with urinary catheters removed sequentially.
Implications:
- Intraperitoneal bladder rupture in children may not present with classic symptoms like gross hematuria or peritonitis.
- Emergency physicians must consider this diagnosis in pediatric patients with unexplained abdominal pain, ascites, hematuria, and renal failure, even after minor trauma.
Background:
Pediatric bladder injuries, though uncommon, typically result from blunt trauma, often associated with motor vehicle collisions. While most bladder injuries are linked to pelvic fractures, this association may be less common in children due to anatomical differences. Bladder injuries are classified as extraperitoneal, intraperitoneal, or combined, with intraperitoneal injuries being rarer but more prevalent in children due to their higher abdominal bladder position. This case report discusses a rare instance of delayed intraperitoneal bladder rupture in a young child following a relatively minor fall, emphasizing diagnostic challenges.
Case Report:
A 4-year-old female presented with new onset abdominal pain, vomiting, and subjective fever three days after a minor fall. Initial evaluation revealed diffuse abdominal tenderness, elevated creatinine, and moderate ascites on ultrasound with no gross hematuria. Despite treatment for presumed acute kidney injury, the patient's condition worsened, leading to the identification of a large posterior dome bladder rupture via cystography. Surgical repair was performed, and the patient was discharged with a full recovery after sequential removal of urinary catheters. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Intraperitoneal bladder rupture can occur in healthy children after minor trauma and may not present acutely with the classic signs of gross hematuria and peritonitis. Emergency physicians should consider this diagnosis in young children with unexplained ascites, abdominal pain, hematuria, and renal failure, even with only a remote history of minor abdominal trauma.
