Extraperitoneal bladder rupture and posterior urethral injury

i v r i m u e m i n 83-year-old man involved in a car crash presented ith pelvic pain. On admission he was conscious and ooperating; vital signs were stable. Inspection revealed n asymmetry and deformity in the right pelvic area. here was tenderness to palpation in the suprapubic egion, and the right hip movement was painful and imited. A hemorrhagic discharge in the urethral meatus as noticed. The initial pelvic radiographs showed muliple pelvic bone fractures including right acetabular racture and protrusion of the right femoral head. The atient was evaluated by computed tomography (CT) can, which demonstrated multiple displaced fractures of he pelvic girdle and protrusio acetabuli on the right side Figure 1). There was a large amount of extraperitoneal uid in the pelvic area. Retrograde urethrography was hen performed, which demonstrated contrast extravasaion from the posterior urethra and bladder (Figure 2). rethral leakage was prominent at the base of the blader and was also extending to the groin region. The ladder had lost its original shape. Transurethrally aplied contrast agent escaped from the bladder to the elvic space in the form of irregular, stranding densities. his radiographic appearance of extravasation is consisent with extraperitoneal rupture of the bladder. Major bladder injury occurs in approximately 10% of atients sustaining blunt trauma with pelvic fracture (1). ladder injuries resulting from pelvic fracture may take ne of two forms—contusion or rupture. Contusion of