PMC2630992_01
Retrograde cystography (A) performed on day 4 and sagittal reconstruction image of CT cystography (B) performed later. A: Leakage of extraperitoneal contrast medium outside the bladder is observed (arrows) B: In the sagittal reconstruction CT image, leakage of extraperitoneal contrast medium from the site shown by arrowheads is observed. The base of the bladder is positioned at the pubic bone inferior margin.
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PMC2630992_01_1757-1626-2-56-1.jpg
F1
On day 4, retrograde cystography (Fig. 1) and CT cystography were performed.
Retrograde cystography (A) performed on day 16 and sagittal reconstruction image of CT cystography (B) performed later. A: The urinoma extending to the left thigh is enlarged when compared with day 4 (arrows). B: In the sagittal reconstruction CT image, the laceration is more clearly defined (arrowhead). The base of the bladder is positioned at the pubic bone inferior margin lower than the image obtained on day 4.
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PMC2630992_01_1757-1626-2-56-2.jpg
F2
As shown in Fig. 2, the urinoma had become enlarged.
Surgical findings. A midline incision of the lower abdomen was made and the incision was extended through a front of the pubic symphysis to the left thigh. A bladder laceration was found in the inferior margin of the pubic symphysis. Partial laceration of the left femoral adductor muscle at the pubic insertion and an urinoma extending from the anterior surface of the pubic bone to the left thigh were observed. The wall of the urinoma had changed to glossy membranous tissue with a flat smooth surface.
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PMC2630992_01_1757-1626-2-56-3.jpg
F3
Surgical findings (Fig. 3) revealed that the bladder was not anchored because of severe lacerations in the urogenital diaphragm, and had a laceration of about 3 cm in the anterior surface of the bladder neck.