Case Report


A case of blunt abdominal trauma resulting in significant bladder injury (AAST grade IV)

1 Clinical Fellow, Urology, The Mid and South Essex NHS Foundation Trust, Southend-on-Sea, Essex, United Kingdom

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Divya Bheenick

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Article ID: 100027Z15DB2022

doi: 10.5348/100027Z15DB2022CR

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How to cite this article

Bheenick D. A case of blunt abdominal trauma resulting in significant bladder injury (AAST grade IV). J Case Rep Images Urol 2022;7(2):11–16.

ABSTRACT


Introduction: Bladder injuries are uncommon and its diagnosis is often missed. However, in patients presenting with blunt abdominal trauma, bladder, and other lower urinary tract injuries must be ruled out using adequate investigations.

Case Report: A 33-year-old male presented to the Emergency Department 24 hours after a fall, complaining of lower abdominal pain and inability to void. Examination revealed a mildly distended abdomen with no signs of peritonism. A random bladder scan showed a volume of 583 mL. Basic investigations showed the patient to be in acute kidney injury (AKI) stage III with a creatinine of 350 mmol/L. Clinical findings were suggestive of a bladder injury. However, due to the rarity of such cases, clinicians reviewing the patient did not think of a bladder injury as one of the differential diagnoses. Instead of also requesting for a computed tomography (CT) cystography, only a trauma CT abdomen and pelvis with contrast was requested which demonstrated an intraperitoneal bladder injury. The patient was taken to theater for an emergency laparotomy and repair of a 4 cm bladder laceration. According to the American Association for the Surgery of Trauma (AAST) classification, the patient had a Grade IV bladder injury. A cystogram performed 4 weeks after the surgery showed no urine leak and the urethral catheter was removed. Fortunately, no harm was brought to the patient.

Conclusion: Intraperitoneal bladder injuries, if missed, can be associated with serious morbidities and even increase the risk of mortality.

Keywords: Intraperitoneal bladder injury, Surgery, Trauma

SUPPORTING INFORMATION


Acknowledgments

Mr T. Chang Urology Consultant

Author Contributions

Divya Bheenick - Conception of the work, Design of the work, Acquisition of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Guaranter of Submission

The corresponding author is the guarantor of submission.

Source of Support

None

Consent Statement

Written informed consent was obtained from the patient for publication of this article.

Data Availability

All relevant data are within the paper and its Supporting Information files.

Conflict of Interest

Author declares no conflict of interest.

Copyright

© 2022 Divya Bheenick. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.