PDF(Pubmed)
Abstract：
BACKGROUND: 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.
METHODS: 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.
METHODS: The diagnosis of delayed intraperitoneal bladder rupture primarily relied on intraoperative observations.
METHODS: An emergency exploratory laparotomy was performed, revealing a linear rupture at the dome of the bladder. Subsequently, the bladder rupture was repaired.
RESULTS: Postoperative cystography demonstrated full recovery and the patient was discharged 28 days post-surgery. The postoperative recovery was uneventful without any complications.
CONCLUSIONS: 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.
METHODS: 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.
METHODS: The diagnosis of delayed intraperitoneal bladder rupture primarily relied on intraoperative observations.
METHODS: An emergency exploratory laparotomy was performed, revealing a linear rupture at the dome of the bladder. Subsequently, the bladder rupture was repaired.
RESULTS: Postoperative cystography demonstrated full recovery and the patient was discharged 28 days post-surgery. The postoperative recovery was uneventful without any complications.
CONCLUSIONS: 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.
摘要：
背景：延迟性腹膜内膀胱破裂是一种罕见的临床表现，常因其非特异性临床表现而被忽视和误诊。然而,文献仅提供了有限数量的报告由腹部钝性损伤导致的腹膜内膀胱破裂延迟的病例。
方法：一名72岁的女行人被车辆撞到，突然，受伤后第8天出现严重腹痛。腹部B超显示腹腔积液明显积聚。腹部穿刺取回了血汗腹水。然后病人被迅速转移到我们医院。转让时，体格检查显示患者生命体征稳定，伴有轻度腹胀,轻微的压痛,紧张,没有反弹压痛。尿液分析检出镜下血尿，而对比增强计算机断层扫描（CT）显示腹腔内有大量液体积聚，没有实体器官损伤的证据，膀胱被充分填充。
方法：迟发性腹膜内膀胱破裂的诊断主要依靠术中观察。
方法：进行了紧急剖腹探查术，在膀胱的圆顶处显示线性破裂。随后，膀胱破裂得到修复。
结果：术后膀胱造影显示完全康复，患者在术后28天出院。术后恢复顺利，无任何并发症。
结论：在CT中观察到的扩张良好的膀胱并不能明确排除膀胱损伤的可能性。由于CT膀胱造影期间膀胱充盈不全，可能会出现假阴性。逆行膀胱造影可以识别CT膀胱造影漏诊的病例。在大量腹腔内游离液体的情况下，对于没有并发实体器官损害的闭合性腹部创伤患者，应积极考虑手术干预。
方法：一名72岁的女行人被车辆撞到，突然，受伤后第8天出现严重腹痛。腹部B超显示腹腔积液明显积聚。腹部穿刺取回了血汗腹水。然后病人被迅速转移到我们医院。转让时，体格检查显示患者生命体征稳定，伴有轻度腹胀,轻微的压痛,紧张,没有反弹压痛。尿液分析检出镜下血尿，而对比增强计算机断层扫描（CT）显示腹腔内有大量液体积聚，没有实体器官损伤的证据，膀胱被充分填充。
方法：迟发性腹膜内膀胱破裂的诊断主要依靠术中观察。
方法：进行了紧急剖腹探查术，在膀胱的圆顶处显示线性破裂。随后，膀胱破裂得到修复。
结果：术后膀胱造影显示完全康复，患者在术后28天出院。术后恢复顺利，无任何并发症。
结论：在CT中观察到的扩张良好的膀胱并不能明确排除膀胱损伤的可能性。由于CT膀胱造影期间膀胱充盈不全，可能会出现假阴性。逆行膀胱造影可以识别CT膀胱造影漏诊的病例。在大量腹腔内游离液体的情况下，对于没有并发实体器官损害的闭合性腹部创伤患者，应积极考虑手术干预。
