Rare Case of Intra and Extra Peritoneal Urinary Bladder Rupture following Motor Vehicle Accident (MVA)

Introduction: Bladder injuries are uncommon (approximately 1.6% of blunt abdominal trauma victims). Signs that raise the index of suspicion for bladder rupture include gross hematuria, pelvic fracture, acute kidney injury and little to no urine output with catheterization. A static or computed tomography (CT) cystogram should be performed and can be used to diagnose bladder injury. American urological association (AUA) guidelines recommend that intraperitoneal bladder ruptures be surgically repaired and uncomplicated extraperitoneal bladder injuries be managed conservatively with catheter placement.

Case Report: We report a case of 24year old male, victim of Motor Vehicle Accident (MVA), brought by ambulance in an unconscious state, with GCS-3/15, nonrecordable pulse and BP, right testes eviscerated through right inguinal lacerated wound, after primary survey, physiological optimization through fluid resuscitation and immobilization by slabs to address pelvic, left tibial, left radial fractures done. Clinical signs raised suspicion of intra and extraperitoneal bladder rupture. Patient regained consciousness after initial resuscitation and prepared for exploration. Intraperitoneal as well as extraperitoneal rupture of urinary bladder repaired along with right orchidopexy. Course of the patient in surgical ward was uneventful followed by transfer to orthopedic unit for management of skeletal injuries after successful removal of all the drains and suprapubic catheter.

Discussion: Urinary bladder injury though uncommon of all blunt abdominal trauma cases when presented with classical signs and symptoms should be evaluated and be managed by multidisciplinary team approach to maximize the outcome, reducing morbidity and mortality related to all injuries either conservatively or surgically when indicated.

Conclusion: We present a rare case of intra and extraperitoneal urinary bladder rupture following MVA assessed, resuscitated, and managed surgically with uneventful postoperative recovery.