Department of Traumatology, Chongqing Emergency Medical Center/Chongqing University Central Hospital, Chongqing, China.
Medicine (Baltimore). 2024 Feb 2;103(5):e37147. doi: 10.1097/MD.0000000000037147.
Delayed intraperitoneal bladder rupture is a rare clinical occurrence, frequently overlooked and misdiagnosed due to its nonspecific clinical manifestations. However, literature provides only a limited number of cases reporting delayed intraperitoneal bladder rupture resulting from blunt abdominal injury.
A 72-year-old female pedestrian was struck by a vehicle and experienced sudden, severe abdominal pain on the 8th day following the injury. Abdominal B-ultrasound revealed a significant accumulation of peritoneal effusion. The abdominal puncture retrieved serosanguinous ascites. Then the patient was promptly transferred to our hospital. Upon transfer, the physical examination revealed the patient vital signs to be stable, accompanied by mild abdominal distension, slight tenderness, tension, and an absence of rebound tenderness. Urinalysis detected microscopic hematuria, while contrast-enhanced computed tomography (CT) revealed considerable fluid accumulation in the abdominal cavity, without evidence of solid organ damage, and the bladder was adequately filled.
The diagnosis of delayed intraperitoneal bladder rupture primarily relied on intraoperative observations.
An emergency exploratory laparotomy was performed, revealing a linear rupture at the dome of the bladder. Subsequently, the bladder rupture was repaired.
Postoperative cystography demonstrated full recovery and the patient was discharged 28 days post-surgery. The postoperative recovery was uneventful without any complications.
A well-distended bladder observed in CT does not definitively rule out the potential for bladder injury. False negatives may occur due to incomplete bladder filling during CT cystography. Retrograde cystography can identify cases missed by CT cystography. In cases of substantial intra-abdominal free fluid, surgical intervention should be actively considered for patients with blunt abdominal trauma without concurrent solid organ damage.
延迟性腹腔内膀胱破裂是一种罕见的临床情况，由于其临床表现不具特异性，常被忽视和误诊。然而，文献中仅报道了少数因钝性腹部损伤导致延迟性腹腔内膀胱破裂的病例。
一位 72 岁女性行人被车辆撞击，伤后第 8 天突发剧烈腹痛。腹部 B 超显示大量腹腔积液。腹部穿刺抽取血性腹水。随后患者被迅速转至我院。转院时，患者生命体征平稳，仅表现为轻度腹胀、轻度压痛、紧张，无反跳痛。尿分析显示镜下血尿，增强 CT 显示腹腔内大量积液，无实质器官损伤证据，膀胱充盈良好。
延迟性腹腔内膀胱破裂主要依靠术中观察。
行急诊剖腹探查术，发现膀胱顶部线性破裂。随后进行膀胱破裂修补术。
术后膀胱造影显示完全恢复，患者术后 28 天出院。术后恢复顺利，无并发症。
CT 显示膀胱充分膨胀并不能明确排除膀胱损伤的可能性。CT 膀胱造影时膀胱充盈不完全可能导致假阴性。逆行性膀胱造影可发现 CT 膀胱造影漏诊的病例。对于有大量腹腔游离液体而无合并实质器官损伤的钝性腹部创伤患者，应积极考虑手术干预。
