PMC4304632_01
Coronal section of CT performed prior to lithotripsy: Both kidneys normal in size; bilateral staghorn calculi larger on the right side; no hydronephrosis; empty urinary bladder with bladder stone measuring 1.5 cm in diameter.
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Fig1
Empty bladder contained a stone of 1.5 cm in diameter. (Figure 1) Gallstones were present.
Ultrasound scan of urinary bladder, performed seven days after vesical lithotripsy: Top panel: a large bladder clot measuring 6 x 
9.2
x
6.4 cm in size, volume 181mls was present. The bladder catheter was in situ. Bottom panel: The outline of urinary bladder was intact; there was no evidence of discontinuity of bladder wall to suggest rupture.
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Fig2
There was a large bladder clot measuring 6 x 9.2 x 6.4 cm in size, volume 181 mls. (Figure 2) The bladder catheter was in situ.
Top panel: Axial section of CT of abdomen performed five days after vesical lithotripsy: A 8
 x 6.6
 x 5.6 cm area of high attenuation within slightly distended urinary bladder was seen, which represented clots within the urinary bladder. The outline of urinary bladder was intact. Urinary catheter was in situ. Bottom panel: Axial section of CT abdomen with oral positive contrast, performed 12 days after vesical lithotripsy (two days after cystoscopy and clot evacuation) when the patient developed abdominal distension: A large 9 x 8 x 4.5 cm intra-peritoneal haematoma, at the superior aspect of dome of urinary bladder. There was 2.5 x 2 cm defect/perforation of the urinary bladder wall superiorly at the site of the haematoma).
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Fig3
There was 2.5 x 2 cm perforation of the urinary bladder wall superiorly at the site of the haematoma. (Figures 3, 4 and 5) Urinary catheter was in situ.
Top panel: Sagittal section of CT of abdomen performed five days after vesical lithotripsy showed urinary bladder distended with clots. But the outline of urinary bladder was intact. Bottom panel: Sagittal section of CT abdomen with oral positive contrast, performed 12 days after vesical lithotripsy (two days after cystoscopy and clot evacuation) when the patient developed abdominal distension: A large intra-peritoneal haematoma, at the superior aspect of dome of urinary bladder was seen which was in continuity with the lumen of the bladder. The tip of Foley catheter was abutting on the haematoma.
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Fig4
There was 2.5 x 2 cm perforation of the urinary bladder wall superiorly at the site of the haematoma. (Figures 3, 4 and 5) Urinary catheter was in situ.
Top panel: Coronal section of CT of abdomen performed five days after vesical lithotripsy showed urinary bladder almost filled with clots. The outline of urinary bladder was intact. Bottom panel: Sagittal section of CT abdomen with oral positive contrast, performed 12 days after vesical lithotripsy (two days after cystoscopy and clot evacuation) when the patient developed abdominal distension: A large intra-peritoneal haematoma, at the superior aspect of dome of urinary bladder was seen with gas locules. There was a defect in the urinary bladder wall superiorly, at the site of the haematoma, indicative of bladder rupture/perforation.
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Fig5
There was 2.5 x 2 cm perforation of the urinary bladder wall superiorly at the site of the haematoma. (Figures 3, 4 and 5) Urinary catheter was in situ.
Follow-up non-contrast CT of abdomen, performed three months after cystoscopic clot evacuation: Axial section shows intact bladder outline; no perivesical haematoma.
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Fig6
This CT revealed resolution of the previously seen large amount of intraperitoneal free fluid, perivesical haemorrhage, abdominal wall oedema, and subcutaneous gas in right costal margin region. (Figures 6 and 7) There was no CT evidence of large or small bowel obstruction.
Follow-up CT, performed three months after cystoscopic clot evacuation: Coronal section shows complete resolution of bladder haematoma and bladder perforation.
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Fig7
This CT revealed resolution of the previously seen large amount of intraperitoneal free fluid, perivesical haemorrhage, abdominal wall oedema, and subcutaneous gas in right costal margin region. (Figures 6 and 7) There was no CT evidence of large or small bowel obstruction.