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

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.