About two percent of the cases of abdominal operations are assigned to ruptures of the bladder. This organ is rarely damaged due to the protection of the pelvic bones.
The bladder is a hollow organ that stores urine after the kidneys have cleared the blood. The emptying of the bladder occurs by creating pressure on the walls of the bladder by the muscles. This opens the urinary canal, through which urine is excreted.
The empty organ is protected from damage by the pelvic bones, but when overflowing, the top of the bladder protrudes beyond the border of the pelvis in an upward direction. This area is vulnerable and can rupture if injured.
Causes of damage
Rupture of the bladder most often occurs as a result of injury. This phenomenon can be observed with penetrating wounds from cold or firearms, as well as with serious fractures of the pelvis, when there is a high probability of damage to the bladder by bone fragments. Such situations are observed as a result of an accident, when falling on the stomach.
Bladder rupture can occur during medical interventions. For example, catheterization, cystoscopy,endoscopy. Sometimes a bladder rupture occurs during delivery.
The cause of the rupture may be an infection that leads to a violation of the outflow of urine. Most often, this variant of the development of the disease is observed in men with prostatitis, when the inflamed prostate gland compresses the urinary duct and urine accumulates in the bladder, causing stretching and then rupture of its walls.
Symptoms
The symptoms of bladder rupture are divided into closed and open. The first type appears:
- bloating;
- urine accumulates in the abdomen;
- pain in the lower abdomen that radiates throughout the abdomen after a few hours;
- blood in urine;
- small urination;
- after a while, symptoms of peritonitis appear.
Extraperitoneal rupture of the bladder causes hematuria, pain in the pubic area, urge to urinate.
With an open type of bladder injury, there is pain throughout the abdomen. Due to the appearance of pain syndrome, patients note tension in the abdominal muscles, complain of urinary retention. When you try to go to the toilet, there is pain, and a portion of urine is stained with blood.
When the bladder bursts, the patient feels a shock. When injured by fragments, hemorrhage into the pelvic tissue can occur. With such an injury, the doctor removes all the fragments, and also installs a drain for the outflow of blood and urine that has entered the cavity.
For extraperitoneal tears above the pubisinfiltration may occur. A few days later, purulent inflammation appears on the skin, involving the tissues of the perineum, thighs, scrotum, and lower abdomen in the pathological process. With the development of the disease, there is an increase in the symptoms of intoxication. The patient has an increase in body temperature, tachycardia.
Diagnosis
When examining a patient, if there are no injuries, an anamnesis must be collected. From it, the doctor can assume an organ injury. For example, a man who has a history of chronic prostatitis or who has complained of pain when urinating may see a doctor. This suggests prostatitis, which can lead to bladder injury.
At the appointment, the doctor must specify when and with what symptoms the pathology began. This may be a violation of urination, severe or mild pain. Be sure to specify what medical procedures were performed and when. Sometimes the cause of the rupture is an incorrectly performed bladder catheterization, some types of diagnostics.
A urinalysis is mandatory. If there is blood in it, a preliminary diagnosis can be made. The rupture of the bladder is finally detected after instrumental methods of examination.
To make a diagnosis, the doctor relies not only on complaints and clinical manifestations, but also on the data of cytoscopy, cytography and other examination methods. To determine the rupture of the bladder, it is injected insidecontrast agent. A few minutes after its application, an x-ray is taken.
According to the prescription, the patient can undergo computed tomography. It allows you to get a three-dimensional image of the organ, as well as to see exactly where the damage is located, to set the length of the gap.
Types of gaps
Diagnosis allows you to determine the type of gap. It can be intraperitoneal, extraperitoneal, penetrating, or a combination of extraperitoneal and intraperitoneal injury.
When the bladder is ruptured intraperitoneally, urine can lead to peritonitis. This is due to the fact that urine enters the abdominal cavity, which causes a complication. To remove it, an emergency operation is scheduled. The doctor makes an incision on the anterior wall of the peritoneum, through which the rupture site is sutured, and all urine that has entered the cavity is removed. After the operation, the patient walks with a catheter through which urine is drained from the damaged organ. This is necessary so that all damage sites have time to heal.
With extraperitoneal damage, a rupture is observed on the side or at the bottom of the organ. Signs of rupture of the bladder - the appearance of blood in the urine. Usually this type of injury occurs when the catheter is not properly fitted.
Sometimes an injury results from a penetrating wound that requires surgery. In this form, adjacent tissues and organs are usually damaged.
Possible Complications
The consequences of bladder rupture are similar in different cases. Most often, trauma leads to peritonitisand osteomyelitis. Fistulas are less common, abscesses form, and the skin is broken.
When ruptured, internal bleeding occurs. It can lead to a decrease in pressure, an increase in heart rate. If timely treatment is not carried out, then the pathology can be fatal.
Damage of the bladder leads to the penetration of microorganisms into tissues and organs located near the bladder. Due to the development of pathogenic microflora, symptoms of inflammation of the pelvic bones, peritonitis, fistulas appear, and anemia increases. With timely access to a doctor, you can hope for a positive result of treatment.
Prevention
Most often, the rupture occurs when the lower abdomen is injured. To avoid damage to the bladder, you should beware of situations in which the lower abdomen can be traumatized. It is also necessary to consult a doctor in a timely manner if pain occurs when urinating.
Treatment methods
There are two types of treatment for a ruptured bladder: operative and non-operative. Conservative treatment is prescribed for minor bruises, bumps.
An operative method is prescribed if another method of treatment does not give the desired result. Surgical intervention is accompanied by an incision in the abdominal wall, through which the injury site is sutured. A drainage is installed near the affected organ, through which urine and blood drain.
Diet
Rupture treatment needs adjustmentnutrition. The patient is forbidden to eat fatty, fried, spicy, s alty foods. Also, you can not eat foods that cause increased excretion of urine from the body. Alcohol, sweets, flour dishes are completely excluded from the diet. Preference is given to light products, best of plant origin.
Failure to diet can cause pain, suture separation, and suppuration. To prevent this from happening, it is necessary to strictly monitor nutrition during rehabilitation.
After a bladder rupture, the healing process takes about ten days. At this time, the patient is placed a catheter that provides a normal outflow of urine. After the bladder has healed, the patient can return to their normal lifestyle. Usually, after a month, people can gradually introduce their favorite foods into the diet, drink drinks. In two months, there will be no trace of the gap. In a year, the place of surgical intervention on the surface of the abdomen will be invisible.
