Bladder injury by dhanush
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few simple slides about bladder injury purely for lecture purposes
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Bladder injury by dhanush
- 1. URINARY B ADDE L R INJURY By DHANUSH ANAND ROLL NO : 21
- 2. BLADDER INJURY ∗ Traumatic injury of the bladder and urethra involves damage caused by an outside force. ∗ Traumatic injury to the bladder is uncommon. Only 8 - 10% of pelvic fractures lead to bladder injury. ∗ Injury may occur if there is a blow to the pelvis severe enough to break the bones & cause bone fragments to penetrate the bladder wall.
- 3. Causes of bladder injury ∗ Road traffic accidents ∗ Blow,kick or fall ∗ Stabs,gunshot injuries ∗ Endoscopic trauma ∗ Diathermy ∗ Instrumentations eg. During hysterectomy,herniotomy, excision of rectum,LSCS etc
- 4. Mechanism of bladder injury Perforation of bladder dome during Veress needle/trocar insertion Incidental cystotomy during development of bladder flap & VVS in routine/radical Hysterectomy
- 6. INTRAPERITONEAL RUPTURE ∗ Occurs in 20% of bladder rupture cases ∗ Occurs due to blow, kick or fall ∗ Blunt trauma more likely to result in intraperitoneal rupture in children than adults; ∗ Since the pediatric bladder is more intraperitoneal ∗ The adult bladder dome remains mostly extraperitoneal ∗ Blunt trauma in an adult can result in intraperitoneal rupture only if the bladder is fully distended bladder
- 8. CLINICAL F AT E URES ∗Sudden pain in suprapubic region ∗Shock & syncope ∗Diffuse abdominal pain ∗Abdominal distention ∗Lately results in peritonitis, with guarding rigidity , rebound tenderness. ∗Patient does not have the desire to micturate
- 9. MANAGE E M NT (A)INVESTIGATIONS ∗ Plain x-ray shows ground glass appearance ∗ Presence of urine is confirmed by peritoneal tap ∗ Retrograde cystography ∗ CT scan abdomen ∗ Ultra sonography
- 10. cystogram
- 11. (B)TREATMENT The goals of treatment are to: ∗Control symptoms ∗Repair the injury ∗Prevent complications
- 12. ∗ INJURY REPAIR ∗ Emergency laprotomy is th only treatment for intraperitoneal rupture ∗ Bladder tear is sutured in two layers using vicryl ,peritoneal wash is given ∗ Malecot’s catheter is placed from above as SPC ∗ Prevesical space & peritoneal cavity are drained separately ∗ Foley’s catheter from below is also passed ∗ Antibiotics is given to prevent sepsis
- 13. EXTRAPERITONEAL BLADDER RUP TURE ∗ Extraperitoneal rupture is the most common type ∗ Occurs in 80% of bladder rupture cases ∗ Extraperitoneal bladder rupture occurs secondary to adjacent pelvic fracture or an avulsion tear at fixation points of puboprostatic ligaments ∗ It occurs commonly in a Non Distended Bladder; such as in road Bladder traffic accidents.
- 15. CLINICAL F AT E URES ∗ Collection of urine& blood in the extraperitoneal space in front ∗ Abdominal fullness ∗ suprapubic tenderness & pain ∗ Scrotal swelling ∗ Strangury & inability to micturate ∗ Often associated with shock & other injuries
- 16. MANAGEMENT (A) INVESTIGATIONS ∗Plain x-ray shows fractured pelvis ∗Cystogram shows leak from the bladder
- 17. TREATMENT The bladder is exposed extraperotoneally;the tear is identified & sutured. Extraperitoneaal space is irrigated with normal saline Bladder is closed with a SPC using malecot’s catheter & a drain is placed in prevesical space If there is any urethral injury it should also be treated
- 18. COMPLICATIONS OF BLADDER INJURY ∗ Cystitis & pyelonephritis ∗ Peritonitis ∗ Pelvic abscess ∗ Vesiculovaginal or retrovesical fistula ∗ Paralytic ileus ∗ Haemorrhage ∗ Mortality is 100% without surgical intervention
- 19. RE E NCE F RE ∗ SRB’S manual of surgery ∗ Bailey & love’s short prcactise of surgery ∗ PUB MED . COM