Bladder injury is one of the most severe injuries to the organs of the genitourinary system and occupies a special place in the problem of injury (1-3% of cases among injuries to other organs). Based on the anatomical structure and localization of the bladder, we can say that it is a hollow muscular organ located in the intraperitoneal space and thus protected from external influences, and therefore injury. Goal. to analyze a non-traumatic rupture of the bladder using the example of a clinical case. Materials and methods. In the course of this study, a clinical case of the urology department at the Tver Emergency Hospital was analyzed. Results. At the time of the examination, the patient noted abdominal pain, most pronounced in the lower regions (suprapubic region). An ultrasound examination and a CT scan were performed, which revealed a large amount of fluid in the abdominal cavity. After examination by the therapist and the surgeon, a preliminary diagnosis was made – "Closed abdominal injury, intraperitoneal rupture of the bladder," after which it was decided to urgently close the rupture with drainage of the abdominal cavity. Conclusions. Intraperitoneal bladder injury is a rather dangerous injury that can be accompanied by a number of complications. The complexity of the clinical picture makes diagnostic examination difficult.
Introduction. Bladder injury is one of the most severe injuries to the organs of the genitourinary system and occupies a special place in the problem of injury (1-3% of cases among injuries to other organs) [1]. Based on the anatomical structure and localization of the bladder, we can say that it is a hollow muscular organ located in the intraperitoneal space and thus protected from external influences, and therefore injury. Direct non-traumatic ruptures are quite rare among injuries to internal organs, according to statistics, in an average of 26% of cases [2]. This type of injury is expressed by a rather large defect, and in the absence of surgical treatment is accompanied by a number of complications. The variability and variety of etiological factors that cause the appearance of this pathology, and the clinical picture that complements it, can lead to delayed diagnosis and, as a result, difficulties in treatment. When an organ is ruptured, the victim cannot adequately assess his condition, and the features of the anatomy of the cellular space can lead to the development of complications such as urinary infiltration, peritonitis, and other pathologies requiring emergency surgery [3].
The purpose of the work is to analyze a non-traumatic rupture of the bladder using the example of a clinical case.
Materials and methods of research. In the course of this study, a clinical case of the urology department at the Tver Emergency Hospital was analyzed. The results of the examinations were taken into account, namely: the results of an X-ray examination (computed tomography of the abdominal cavity and retroperitoneal space), an ultrasound protocol, a clinical blood test, an analysis of the diaries of the doctor responsible for the treatment, the conclusion of the attending physician together with the head of the department, preoperative epicrisis, discharge epicrisis.
The results of the study. At the time of the examination, the patient noted abdominal pain, most pronounced in the lower regions (suprapubic region), nausea and vomiting, which brought relief, and a temperature of 37.2. The condition was of moderate severity. He considers himself sick since 08/01/2024. The patient has a history of mixed asthma. An ultrasound examination and a CT scan were performed, which revealed a large amount of fluid in the abdominal cavity. The patient was transferred to the urology department for further examination and further treatment.
After examination by the therapist and the surgeon, a preliminary diagnosis was made – "Closed abdominal injury, intraperitoneal rupture of the bladder," after which it was decided to urgently close the rupture with drainage of the abdominal cavity.
08.08.2024 the patient underwent surgery. During the operation, the abdominal fluid was evacuated, the defect in the bladder wall was sutured, and then it was drained. The integrity of the peritoneum has been restored.
The postoperative period was smooth in the urology department. During his stay in the hospital, the patient received infusion therapy, antibacterial therapy and symptomatic treatment. There are no signs of inflammation. The pain is relieved. The patient was discharged in satisfactory condition on 08/26/2024 under the supervision of a polyclinic urologist.
Conclusions. Intraperitoneal bladder injury is a rather dangerous injury that can be accompanied by a number of complications. The complexity of the clinical picture makes it difficult to diagnose and does not allow for a clear determination of both the location of the injury and its nature, however, in the case of a complete or incomplete rupture of the bladder, surgery is the only possible way out to save the patient's life.
Email: ammorozovv@gmail.com
ORCID iD: 0009-0001-6717-8685
Russian Federation, 170100, Russia, Tver, Sovetskaya str., 4
Email: ammorozovv@gmail.com
ORCID iD: 0000-0003-4213-5379
SPIN-code: 6815-9332
PhD., Associate Professor of the Department of General Surgery
Russian Federation, 170100, Russia, Tver, Sovetskaya str., 4
Author for correspondence.
Email: ammorozovv@gmail.com
ORCID iD: 0009-0001-0354-6872
Resident of the Department of Urology
Russian Federation, 170100, Russia, Tver, Sovetskaya str., 4There are no supplementary files to display.
