The multiple injured patient with bladder trauma.

Trauma of the bladder from external force is associated with severe multiple injuries and the resulting mortality rate is substantial. The major associated injury was fracture of the pelvic bones which was present in 346 (83%) of the 417 patients with bladder trauma. Contusion of the bladder was present in 280 (67%), intraperitoneal rupture in 53 (13%), extraperitoneal rupture in 76 (18%), and both intra- and extraperitoneal rupture in eight (2%). Radiologic evaluation of the bladder by a retrograde cystogram using 400 ml of dye is recommended to diagnose the type of bladder injury. Nonoperative (catheter) management of extraperitoneal rupture of the bladder was used in 18 patients and resulted in complications in four of the 18.