Blunt abdominal trauma with extraperitoneal urinary bladder injury

Case contribution: Dr Radhiana Hassan


  • A 28 years old man
  • Previously healthy, Alleged mva
  • Admitted for pelvic bone fractures
  • Noted poor urine output after 2 days post trauma
Contrast-enhanced CT abdomen and pelvis in axial plane soft tissue window
CT scan of pelvis in axial plane bone window

CT scan findings:

  • No injury of liver, spleen, pancreas and both kidneys are seen.
  • Contrast extravasation from urinary bladder (yellow arrows)
  • Irregular pooling of extravasated contrast material at perivesicle region
  • No outlining of bowel loops or intraperitoneal extension of contrast
  • Multiple fractures (white arrows) involving the left sacral alar and both pubic rami.
  • No widening of sacroiliac joint and symphysis pubis

Diagnosis: Extraperitoneal urinary bladder injury


  • Bladder injury is categorized anatomically as being either intraperitoneal (15–30%), extraperitoneal (40–60%), or mixed (10–25%).
  • Blunt external trauma to the bladder usually occurs due to rapid acceleration-deceleration forces stressing the fascial attachments of the bladder to the pelvis and horizontal tearing near fascial connections.
  • Extraperitoneal rupture is the most common type of urinary bladder injury, accounting for about 85% of cases.
  • Extraperitoneal injury is usually associated with the posterior bladder wall and fibrous attachments, including the pubovesical ligament, puboprostatic fascia in men, superior fascia, and inferior fascia.
  • Approximately 12% of trauma patients have a pelvic ring injury. Additionally, injury to intra-abdominal or pelvic organs occurs in 3–6% of patients with pelvic fractures and 15% with severe pelvic fractures
  • Cystography reveals a variable path of extravasated contrast material.
Author: radhianahassan