PMC6312620_01
Contrast-enhanced CT: pelvic fracture and pelvic hematoma. The bladder cannot be assessed.
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The kidneys were normal and the bladder was empty (Figure 1).
Bladder displaced upwards by the pelvic hematoma. Poor bladder filling with contrast extravasation in the peritoneal cavity.
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A follow-up abdominopelvic CT-scan with excretory phase (14h after admission) demonstrated a nearly empty and upwards displaced bladder, with contrast extravasation into the peritoneal cavity (Figure 2).
Cystography 10 days after surgical exploration and repair of the bladder injury. Note: the bladder is located high in the pelvis.
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Ten days after laparotomy, a cystography proved integrity of the bladder wall repair (Figure 3).
Combined retrograde urethrography (left) and antegrade cystourethrography 3 months after trauma and before urethroplasty.
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Suprapubic drainage was maintained and combined retrograde and antegrade cystourethrography performed at 3 months showed a complete obliteration of the membranous urethra (Figure 4).
Voiding cystourethrogram 2 weeks after anastomotic repair urethroplasty.
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The postoperative course was uneventful, voiding cystourethrogram (2 weeks after urethroplasty) proved no urethral extravasation and the catheter was removed (Figure 5).
PMC6312620_02
Unstable pelvic fracture with pelvic hematoma. Intraperitoneal free fluid.
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Hemodynamic resuscitation was started and urgent contrast-enhanced CT was performed which revealed an unstable pelvic fracture together with large amounts of free fluid in the peritoneal cavity (Figure 6).
Conventional cystography: massive extraperitoneal extravasation at the bladder neck.
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A conventional cystogram demonstrated massive extraperitoneal extravasation at the bladder neck (Figure 7).
Postoperative cystography: full bladder wall integrity.
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The postoperative course was uneventful and after 16 days, a pericatheter voiding cystourethrography demonstrated complete healing of the bladder wall (Figure 8).