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Abstract: After a fall on an electric bicycle, a 40-year-old male with persistent lower abdominal pain did not urinate for 2 hours after the injury, and no urine discharge was seen after a urinary catheter was left in place. Cystography showed that the intravesical contrast agent flowed into the abdominal cavity along the parietal wall of the bladder and the wound was about 2 cm in diameter, which was considered to be a more serious bladder injury with bladder rupture. Under emergency general anesthesia, laparoscopic repair of bladder rupture was performed and supplemented with medication against infection. On outpatient review 1 week after the operation, no extravasation of intravesical contrast was observed, and the incision healed well.
Basic information】Male, 40 years old
Disease Type】Bladder rupture
Hospital】Zhengzhou First People’s Hospital
Date of consultation】April 2021
Treatment plan】Surgery (laparoscopic bladder rupture repair surgery) + medication (levofloxacin hydrochloride injection)
[Treatment period] Hospitalization for 3 days, review after 1 week
Results】The patient urinated smoothly, and the cystogram showed that the bladder fracture was healed.
I. Initial consultation
The patient was a 40-year-old male, complaining of a fall on an electric bicycle 2 hours ago, with direct pressure on the handlebars in the lower abdomen and persistent lower abdominal pain, and holding urine before the injury, but not urinating for 2 hours after the injury. After giving the patient an indwelling urinary catheter, no urine discharge was seen. On examination: the patient’s lower abdomen was bruised and bruised with pressure pain and rebound pain, and there was no bulge in the suprapubic bladder area. After injecting 300 ml of saline into the bladder from the urethral tube, the patient complained of increased pain, and the injection was suspended. The patient complained of worsening of pain, suspended the water injection, and saw 20ml of light red fluid coming out after releasing the ureter.
II. Treatment history
After hospitalization, urgent cystography was performed and 300 ml of contrast agent was injected into the bladder. 300 ml of contrast agent was seen flowing into the abdominal cavity along the parietal wall of the bladder and the wound diameter was about 2 cm. intraperitoneal rupture of bladder was considered. Pelvic CT: no pelvic fracture was seen. Because the patient had intraperitoneal bladder rupture and the actual rupture was larger than that shown by the examination, after communication with the patient, the patient underwent surgical treatment and laparoscopic bladder rupture repair surgery was performed under general anesthesia in emergency.
(Pelvic CT)
III. Treatment effect
Three days after the operation, the patient recovered well, the urinary catheter drained freely, no infection at the surgical incision, no urinary tract infection, the patient’s abdominal pain symptoms were reduced, so the patient was discharged with a urinary catheter. 1 week later, the patient was re-examined in the outpatient clinic, 300 ml of contrast agent was injected from the urinary catheter, no extravasation of contrast agent in the bladder was seen, the incision was removed and healed well. The patient was very satisfied with the treatment result.
IV. Notes
We are glad that the patient was treated promptly without adverse consequences or other complications. After discharge, the patient needs to be advised to make sure to drink more water, and it is recommended to keep the daily water intake above 2000 ml to increase urination. More urine volume can flush the bladder and urethra and prevent inflammation from occurring. In addition, after the patient’s early urinary catheter is removed, it is recommended to try not to hold urine in the short term and urinate regularly to prevent poor healing of the suture opening caused by excessive bladder pressure. After surgery, we should pay attention to nutritional supplementation, eat more food rich in protein and vitamins, and the diet should be as light as possible, avoiding spicy and stimulating food.
V. Personal insight
Bladder rupture is a more serious bladder injury, and the patient in this case is an intraperitoneal bladder rupture, which requires two conditions to be met: first, the bladder is in a distended state, and second, the trauma happens to squeeze or hit the lower abdomen. Once bladder rupture is considered clinically, a cystogram must be done to clarify the location of the rupture and the size of the fissure. If the rupture is small and extraperitoneal, consider leaving a urinary catheter in place with continuous drainage and the rupture may heal on its own. If the fissure is large, especially if it is located within the peritoneum and connected to the abdominal cavity, early surgical closure of the fissure is recommended.