PMC8486555_01
Intraoperative fluoroscopic cystography with images captured in the anterior-posterior view. Fluoroscopic images demonstrate the bladder perforation; however, with a single view, it is unclear whether the extravasation of contrast is intraperitoneal.
CRIU2021-2060572.001.jpg
PMC8486555_01_CRIU2021-2060572.001.jpg
fig1
In order to differentiate between an extraperitoneal and intraperitoneal bladder perforation, a fluoroscopic retrograde cystogram limited to the anterior-posterior view in lithotomy position was performed (Figure 1) using approximately 50 milliliters of iohexol (Omnipaque ) contrast dye; however, the image findings were equivocal.
Intraoperative CT cystogram obtained using an O-arm  surgical imaging system with three-dimensional volumetric reconstruction. Image acquisition in the coronal (top left), sagittal (top right), axial abdomen (bottom left), and axial pelvis (bottom right) planes was obtained. Contrast is visible in the intraperitoneal cavity and around the bowel, confirming the diagnosis of an intraperitoneal bladder perforation. Note the extravasation of contrast into a right inguinal hernia in the axial pelvis plane, also confirming an intraperitoneal bladder perforation.
CRIU2021-2060572.002.jpg
PMC8486555_01_CRIU2021-2060572.002.jpg
fig2