PMC4897093_01
22-year-old man with scrotal gunshot wound. Axial venous phase CT image of the pelvis demonstrates round puncture fracture of the left pubis (arrow).
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This revealed a left testicular hematoma, puncture fracture of the left pubis, bone fragments within the bladder, intraperitoneal fluid, pre-sacral bowel wall thickening and bone fragments in the left L5 lateral recess (Figure 1A, Figure 1B).
22-year-old man with scrotal gunshot wound. Axial venous phase CT image of the pelvis demonstrates dependent bone fragments (arrow) and gas in the bladder (arrowhead).
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This examination demonstrated a distended bladder with a contrast-fluid level but no extravesicular contrast extravasation (Fig. 2).
22-year-old man with scrotal gunshot wound. Axial CT image 10 minutes after contrast administration with the Foley catheter clamped demonstrates a contrast/fluid level, Foley catheter (arrow) and gas (arrowhead) in the bladder but no extravesicular contrast. The distal right ureter (skinny arrow) also contains contrast.
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This examination revealed contrast extravasation into the peritoneal cavity which confirmed the suspected intraperitoneal bladder rupture (Fig. 3A). In addition, there was direct evidence of contrast leaking through the perforation in the posterior wall of the bladder (Fig. 3B).