Bladder rupture associated with pelvic fracture –
Correct Answer: Extraperitoneal
Description: Ans. is 'a' i.e., Extraperitoneal o 80% of bladder injuries are extraperitoneal, and are mainly caused by fracture of pelvis.o Intraperitoneal bladder injuries are usually caused by blunt trauma over a distended bladder, often seen in drunk individual."The bony pelvis protects the urinary bladder very well. When the pelvis is fractured by blunt trauma, fragments from the fracture site may perforate the bladder. These perforations usually result in extra peritoneal rupture".-- Smith s Urology-Pelvic fractures are associated with extraperitoneal type of bladder rupture and membranous urethral injury,o More about Bladder & Urethral injurieso Bladder rupture is of two types:Extraperitoneal - 80% of casesIntraperitoneal - 20% of caseso Urethral rupture is also of two types:Bulbar urethral injury - MCMembranous urethral injury'Extravasation of urine in Bladder & Urethral injuries.o Extravasation of urine (+ blood) in bulbar urethral injuryIt is a superficial extravasation.If the Buck's fascia remains intact, extravasation of blood and urine are confined to the penile shaft. However disruption of Buck's fascia allows extravasated contents into a space limited by colle's fascia forms a scrotal and perineal butterfly hematoma which can extend up the abdominal wall.o Extravasation of urine in Membranous urethral injury & Extraperitoneal bladder rupture.Extravasation is same in bothIt is a deep extravasationUrine extrvasates in the layers of the pelvic fascia and the retroperitoneal tissuesUrine collects in the perivesical space.The typical finding on cystogram is extravasation of contrast material into the pelvis around the base of the bladder.o Intraperitoneal ruptureUsually occurs with a direct blow to lower abdomen with full bladder.Blood & urine will extravasate into the peritoneal cavity producing signs of peritonitis.
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