Bladder Injury
Basics
Description
Description
- Blunt trauma is the most common mechanism
- 10% of pelvic fractures have serious bladder injury
- 80–90% of bladder ruptures have pelvic fracture
- Mortality: 17–22% overall; 60% if combined intraperitoneal/extraperitoneal rupture
Etiology
Etiology
- Mechanism:
- Trauma, 82%
- Blunt trauma: Motor vehicle accident (MVA; 87%), falls (7%), assault (6%)
- Penetrating: Gunshot wound (GSW) (85%), stabbings (15%)
- Iatrogenic 14%: TURP and urologic procedures, gynecologic procedures, obstetric procedures, abdominal procedures, hernia repair, intrauterine device (IUD), orthopedic hip procedures, biopsies, indwelling Foley
- Intoxication 2.9%
- Spontaneous <1%
- Classification:
- Extraperitoneal bladder rupture (62%):
- Almost always associated with pelvic fractures
- Caused by blunt force or fracture fragments
- Intraperitoneal bladder rupture (25%):
- Direct compression of distended bladder
- Caused by rupture of the dome of the bladder
- Combined extraperitoneal and intraperitoneal rupture (12%):
- Highest mortality owing to associated injuries
- Bladder contusion:
- Damage to endothelial lining or muscularis layer with intact bladder wall
- Gross hematuria after extreme physical activity (long-distance running)
- Gross hematuria with normal imaging
- Usually resolves without intervention
- Extraperitoneal bladder rupture (62%):
Pediatric Considerations
- In children, the bladder is an intra-abdominal organ and descends into the pelvis by age 20 yr
- Intraperitoneal rupture is more common in children than adults because the bladder is an abdominal organ
- Bladder injury is more common in children than in adults because the pediatric bony pelvis is less rigid and transmits more force to adjacent structures
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Citation
Schaider, Jeffrey J., et al., editors. "Bladder Injury." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307455/all/Bladder_Injury.
Bladder Injury. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307455/all/Bladder_Injury. Accessed October 15, 2024.
Bladder Injury. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307455/all/Bladder_Injury
Bladder Injury [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 October 15]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307455/all/Bladder_Injury.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Bladder Injury
ID - 307455
ED - Barkin,Adam Z,
ED - Shayne,Philip,
ED - Rosen,Peter,
ED - Schaider,Jeffrey J,
ED - Barkin,Roger M,
ED - Hayden,Stephen R,
ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307455/all/Bladder_Injury
PB - Lippincott Williams & Wilkins
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DB - Emergency Central
DP - Unbound Medicine
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