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Diagnostic difficulties in patients with a ruptured bladder

T Mokoena¹, A G Naidu

¹Department of Surgery, University of Natal Medical School, Durban, South Africa.

The British Journal of Surgery

|January 1, 1995

Summary

Delayed diagnosis of isolated bladder rupture is common, often due to trauma or intoxication. Early consideration of bladder injury is crucial when blood urea and creatinine levels are elevated in patients with abdominal issues and trauma history.

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Point-of-Care Kidney and Genitourinary Ultrasound in Adults: Image Acquisition

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Published on: June 21, 2024

Area of Science:

Urology
Trauma Surgery
Emergency Medicine

Background:

Isolated bladder rupture often presents insidiously, leading to diagnostic delays.
Trauma is a common cause, but the injury may be minor or unrecognized.
Impaired sensation from alcohol, head injury, or paraplegia can mask bladder distension and injury.

Purpose of the Study:

To analyze the presentation, diagnosis, and outcomes of isolated bladder rupture.
To identify factors contributing to delayed diagnosis and management.
To highlight key clinical indicators for suspecting bladder rupture.

Main Methods:

Retrospective review of 44 patients with isolated bladder rupture over 7 years.
Analysis of patient demographics, trauma history, associated conditions, and diagnostic methods.
Evaluation of blood urea and creatinine levels in relation to diagnostic delay.

Main Results:

Mean age of patients was 33.3 years; 33 had a history of trauma.
Mean delay between incident and diagnosis was 5.4 days.
Elevated blood urea (19.6 mmol/l) and creatinine (362 mumol/l) were noted in delayed diagnoses.
Voiding cystourethrography diagnosed 36 cases; laparotomy diagnosed 8.

Conclusions:

Isolated bladder rupture requires a high index of suspicion, especially in patients with trauma or intoxication.
Elevated urea and creatinine levels in the context of abdominal complaints and trauma warrant consideration of ruptured bladder.
Prompt diagnosis and management are essential to improve patient outcomes.