Emergency care for anuria. Why a bladder rupture may occur, emergency care and treatment Intra-abdominal bladder injuries first aid

Anatoly Shishigin

Reading time: 3 minutes

A A

Quite often, due to a careless fall or for other reasons, a person gets injured genitourinary organs. Any injury to organs in the urinary system is fraught with damage due to mechanical impact from the outside.

Depending on which organ is injured, injury may occur Bladder, injury to the ureter or kidney. Other components of the system are not considered, since their location differs in depth, and they are damaged extremely rarely.

What are the causes of injuries to the urinary system?

Most common cause When a kidney is damaged, there is a blunt blow to the lower back. This can happen when you fall from a bicycle, skateboard or snowboard. Also, a kidney defect is often detected during a street fight, when a bruise can be caused tangentially.

The reasons for bladder injury lie in a blow to the area above the pubis, and if the organ is filled with urine, it ruptures. If the bladder was empty, then only a hematoma will occur in the area of the mucous membranes, which will resolve on its own without treatment within a couple of weeks.

A special injury is considered to be a rupture urethra. This happens when you fall on a bicycle frame or into an open sewer manhole.

Reasons that caused closed or blunt injuries, can provoke open injuries. Is it cut or lacerations, stabbed or resulting from a gunshot wound. In the case of participation in hostilities, multiple injuries to the genitourinary organs, as well as others, occurred due to mine explosions, when fragments penetrated the urethra or bladder and ruptured them.

The main symptom of blunt trauma in renal system is strong pain in the lower back, problems urinating and the release of blood clots in the urine. Acute pain is felt from the side of the blow. At physical activity it grows, just like when you urinate. In some cases, a large hematoma appears in this area, completely various shapes and sizes. During deurination, the amount of urine may be reduced; the patient experiences frequent urges, which may not even lead to the release of urine and may be purely imperative. Manifestations of hematuria in such injuries range from small sediment in the fluid to large blood clots, indicating profuse bleeding.

Doctors often note renal hypertension in the artery, characteristic feature kidney damage. This phenomenon often has a malignant etiology and is poorly treated.

Injury to the bladder if it ruptures leads to urine leaking into the abdominal cavity. This can provoke the development of urinary peritonitis. In the absence of proper treatment, such a disease leads to the death of the patient. The person feels intense sharp pains in the abdomen, the walls of the peritoneum are very tense, and the urge to empty the bladder does not arise at all. If a certain amount of urine is released, then most often it appears along with blood and purulent discharge.

If the bladder injury is not accompanied by its rupture, then the manifestations of symptoms in such acute form No. The patient feels some pain in the area above the pubis, as well as minor difficulties with urination. Sometimes traces of blood may appear in the excreted urine, hematuria in in this case often microhematuria.

In case of injuries to the lower back or pelvis, you should immediately seek help from a urologist. Even minor causes can cause organ damage, the symptoms of which will appear after some time. It is the urologist who must determine the degree of injury and the danger of this phenomenon to human health.

Initially, when diagnosing injuries of the genitourinary organs, a survey radiography of all organs located in the abdominal cavity. With the help of such an examination it is possible to identify the presence foreign objects and traumatic substances inside and behind the peritoneum.

To obtain more detailed data, an additional examination is performed - excretory urography. Even if it does not show changes in the structure of the kidney parenchyma, it will maximally reflect the functionality of the organ under study. Usually, when a kidney is injured, there is a failure in the filtration of one of their organs, and when the urethra is ruptured, the contrast agent goes beyond the studied limits.

At ultrasound examination organs of the peritoneal cavity, the morphology of the kidneys and their condition can be determined. Special attention pay attention to the capsule, which may be completely torn or torn. In order to confirm the ultrasound tests, a specialist can perform kidney angiography to study blood flow in the organ.

In case of ruptures of the bladder, voiding cystography is performed, which consists of injecting a contrast agent into the cavity of the urethra. The area of the urethral part is x-rayed, and a contrast agent reveals the most clearly problem areas. If there is no x-ray, a rupture of the organ can be detected with a probing catheter inserted into the peritoneum. If there is a pathology, then blood clots or bloody sediment will be released along with the urine.

For organ diagnostics genitourinary system when they are injured, there is the most effective, CT scan with a contrast agent. It is with such an examination that the results will be especially accurate, while ultrasound and excretory urography multiple deficiencies are noted.

If there are open organ injuries urinary system, a canal with a wound, then a special technique is used - fistulography. The process is characterized by filling this wound channel solutions of brilliant green or methylene blue and a detailed examination.

How to treat injuries to the urinary system?

All trauma patients urinary tract of any etiology must be hospitalized in specialized clinics. Only in a hospital setting is it possible to examine and observe doctors and specialized specialists for the occurrence of complications and the correctness of the chosen treatment regimen in women and men. The prescribed treatment can be either conservative or surgical intervention.

In case of kidney ruptures, surgical intervention is used, in which the organ defect is sutured or completely removed. The operation ends with nephrostomy, the purpose of which is to evacuate the urine that constantly penetrates the surface of the wound after the operation. During the operation, a complete inspection of all tissues near the organ is performed for the presence of foreign objects, especially in cases of kidney injury.

Treatment for a ruptured bladder is carried out in the form of an operation, during which the resulting defect must be repaired by suturing. Surgeons make a suture in two rows, which tightly seals the organ cavity. After surgery, it is important to ensure complete and sufficient evacuation of urine from the inside so that there is no high blood pressure. This is necessary for the integrity of the seams on its walls.

Surgical treatment of rupture of the urethra and urethra is carried out in the traditional way. During the intervention, the resulting defect in the urethra is also sutured and high-quality drainage is ensured.

A conservative treatment regimen for injuries of the urinary system takes place under conditions antibacterial treatment and pain relief from spasms. The medications Ofloxacin, Gatifloxacin and Ceftriaxone should fight bacteria and inflammation. Pain relief is achieved with the help of Ketanov, Diclofenac and Analgin. The duration of the course depends on the severity of the disease and the patient’s condition.

Treatment with folk remedies

A compress on the damaged area can give a positive result. At the same time it is removed pain syndrome, the resorption of the hematoma is accelerated. If there is a rupture and open bleeding, then such methods can be dangerous, since they will delay the call of a specialized specialist. For these reasons, it is necessary to consult a urologist, and only then apply compresses and other methods recommended by traditional medicine.

Limit the patient's nutrition if the bladder is damaged or neighboring organs only in case surgical intervention. The prescribed diet is number zero, which implies complete fasting on the eve of the procedure. This is important so that during anesthesia the patient does not experience a vomiting effect, which complicates the start of the operation.

Postoperative period

Patients are prescribed physical therapy throughout the recovery period after surgery. UHF and darsonvalization are extremely useful, according to experts, for tissue restoration and skin healing. IN mandatory need to drink antibacterial drugs and a course of drugs that restore intestinal microflora.

Possible complications

The most dangerous of possible complications– peritonitis and open or internal bleeding. Ruptures of blood vessels can occur due to injuries to any organ if a large vessel is damaged. All the blood that is released ends up in the cavity of the bladder or in the area behind the peritoneum.

The development of peritonitis occurs when the urinary wall is perforated, when urine penetrates through the defects and fills all the available space inside the peritoneum. This process starts acute inflammation and can be fatal.

Prevention of injuries to the genitourinary system

According to experts, the most dangerous and vulnerable to injury professions are construction workers and motocross racers. During work, they especially strictly need to follow the safety rules and use all possible protective equipment.

Just as often, injuries to the kidney or bladder occur when car accidents. The presence of airbags in the car and the increased comfort of the model are one of the prophylactic agents from damage to the urinary system.

The bladder is an important organ of the urinary system. Any damage to it can lead to serious health consequences. Therefore, it is necessary to remember the first signs of injury and features of therapy.

Features of bladder injury

Bladder trauma refers to any violation of the integrity of its wall. This occurs as a result of external influence. Such injuries are difficult for victims to bear and may have critical consequences. Therefore, when you notice the first symptoms, you must immediately seek help from specialists.

This organ is not protected by anything, so even a small blow to the stomach can lead to damage. Recovery will take a long time. Treatment will be carried out in a hospital setting.

Damage classification

Depending on the location of the damaged area, all bladder injuries can be divided into several categories:

Intra-abdominal. Such injuries often result from the fact that the bladder was full at the time of injury. In this case, the contents spill throughout the abdominal cavity.
Extra-abdominal. These injuries occur when the pelvic bones are fractured. No urine enters the abdominal cavity.
Combined. If, during a fracture of the pelvic bones, the bladder was full, and its damage occurred in several areas at once, then urine spills throughout the abdominal cavity.

If we consider all injuries from the point of view of the type of injury, we can distinguish the following types:

Closed injury. In this case, there is no injury or rupture of the skin and nearby tissues. Internal organs do not contact the external environment.
Open injury. Characterized by skin damage and contact of organs with external factors.

Bladder injuries can also be classified according to severity. In this case, the following groups are distinguished:

Complete organ rupture.
Incomplete rupture of the organ wall.
Injury. Such damage does not imply a violation of the integrity of the bladder.

In some cases, not only the bladder itself is damaged, but also nearby organs. Based on this characteristic, injuries are divided into several categories:

Isolated. Only the bladder itself is damaged.
Combined. At the same time with bladder nearby organs are also injured.

The treatment program will be developed by a specialist based on the type and characteristics of the injury. In this case, the patient will have to spend some time in the hospital.

How does the disease manifest?

In order to correctly determine the treatment method, it is necessary to pay attention to the symptoms that accompany the problem. Among them are:

Pain in the lower abdomen.
Loss of ability to urinate.
Detection of blood in the urine.
Frequent urge to go to the toilet, but no urination occurs. May not stand out a large number of blood.
Signs are detected internal bleeding, for example, falling blood pressure, pale skin, rapid heartbeat.
Signs of developing peritonitis appear. This phenomenon occurs when urine enters the abdominal cavity. These symptoms include: pain that subsides only in a half-sitting position, increased body temperature, increased tone abdominal muscles, attacks of vomiting and nausea, bloating.
If the injury is of an extra-abdominal type, then swelling may appear in the lower abdomen, as well as bluish discoloration of the skin in this area.

When similar symptoms It is necessary to undergo examination and begin treatment as soon as possible. Delay in such a situation can lead to grave consequences.

Main Causes of Injury

You can get a bladder injury in the following situations:

When falling from a height onto any object.
During a stabbing or gunshot wound.
When jumping too quickly. This often happens if the bladder was full during the jump.
When the blow hit bottom part belly.
During the bladder catheterization procedure. When a tube is inserted into an organ in order to ensure a complete outflow of urine, damage to the bladder walls is possible.
During bougienage of the urethra. This procedure involves widening the canal by inserting metal pins into it.
Surgical intervention for fractures of the pelvic bones.
The cause of injury can also be diseases: prostate adenoma, narrowing of the urethra, prostate cancer.

Often injuries occur in a state alcohol intoxication. At the same time, the urge to urinate is dulled.

Basic diagnostic techniques

For staging accurate diagnosis the specialist conducts several diagnostic measures. These include:

Examination of the patient and collection of anamnesis. The doctor questions the victim about complaints, previous similar injuries, and the use of any medicines.
General blood analysis. Allows you to determine the presence of bleeding, determines the level of hemoglobin and red blood cells.
Analysis of urine. The study reveals the presence of red blood cells in the sample.
Ultrasound. An examination is carried out not only of the bladder, but also of the kidneys. This allows you to assess the size and structure of the organ, identify the presence of blood clots, and disturbances in the passage of urine. In addition to this, an ultrasound scan of the entire abdominal cavity may be performed. This helps detect hemorrhages in the abdominal cavity.
Retrograde cystography. A special substance is injected into the bladder, which clearly shows up on an x-ray. The pictures will clearly show the characteristics of the damage and the condition of the pelvic bones.
Urography. The victim is injected with a drug that enters the kidneys. After this is carried out radiographic examination. This technique allows you to determine the location of the injury, as well as the degree of its severity.
MRI. This method is characterized by increased accuracy. It allows you to study the bladder in various projections. Thanks to this, you can find out the nature of the damage, the degree of severity, as well as injuries to nearby organs.
Laparoscopy. Small incisions are made in the lower abdomen. A probe with a camera is inserted through them. Such an examination allows you to determine the presence of bleeding and its intensity, the location of the wound and the presence of associated injuries.
CT scan. This is an x-ray examination method that allows you to obtain a three-dimensional image. With its help, you can accurately determine the nature of the damage, the degree of severity, and the intensity of bleeding.

The choice of a specific technique is based on the available medical institution equipment, characteristics of the patient’s body.

Treatment rules

Modern medicine offers the following therapeutic methods:

Drug treatment. The use of medications is permissible only for minor injuries: a bruise or a slight tear in the bladder wall. Hemostatic and anti-inflammatory drugs and antibiotics are prescribed. In the presence of strong pain painkillers are prescribed. In this case, the patient must adhere to bed rest.
Suturing the bladder laparoscopically or through an incision.
Cystostomy. This procedure is used for men. A small rubber tube is inserted into the bladder to allow urine to flow out.

If urine leaks into the abdominal cavity, drainage will be required. The specific treatment method is selected based on the severity of the injury.

What complications can accompany the injury?

IN severe cases complications of the disease may develop. Among them are:

Urosepsis. An open wound can become infected with microorganisms. As a result, the inflammatory process starts.
State of shock due to heavy blood loss. This manifests itself in loss of consciousness, rapid heartbeat, shallow breathing, and a drop in blood pressure.
Purulent process in the bladder.
Osteomyelitis. This is inflammation of the pelvic bones.
Fistula formation. Blood and urine suppurate near the bladder. This provokes the destruction of part of the organ wall. This creates a channel through which urine can flow into the abdominal cavity.
Peritonitis. Appears when urine enters the abdominal cavity.

If such consequences occur, an additional set of therapeutic measures will be required. The program is developed by the treating specialist based on the characteristics of the disease.

How to prevent injury?

In order to avoid severe consequences For health, you must adhere to the following recommendations:

Promptly identify and treat prostate diseases.
Try to avoid traumatic situations.
Refuse bad habits, especially from drinking alcohol.
Monitor prostate-specific antigen levels regularly. Its concentration increases in diseases of the prostate gland.

If an injury does occur, you must be observed by a urologist for three months after the end of treatment.

Timely diagnosis and proper treatment of injury will help avoid serious consequences for good health. At the first warning signs, consult a doctor.

4315 0

Ureteral injury

Ureteral injuries are the rarest of the genitourinary tract injuries caused by external trauma. At blunt trauma A rupture may occur at the origin of the ureter from the pelvis (or slightly lower) as a result of hyperextension or separation of the lower end of the ureter, fixed to the triangle of the bladder. With a penetrating injury, contusion of the ureter, as well as its partial or complete rupture, is possible.

Contusion may occur when gunshot wound, if the bullet passes close to the ureter, which leads to damage to the vessels of the ureteral wall, including bleeding or thrombosis. Inspection of the wound shows that the bullet passed by the ureter, while its wall appears intact or slightly damaged. If vascular thrombosis occurs in the wall of the ureter, necrosis is subsequently observed with the formation of a urinary fistula.

Bladder damage

In children, the bladder is an intra-abdominal organ, but in adults it is located much lower and is surrounded by pelvic bones, which protects it from the most severe damage due to trauma to the abdomen and pelvis. Injuries to the bladder are second in frequency after kidney injury and are usually combined with a fracture of the pelvic bones.

Bladder contusion

A bruise of the bladder is understood as a violation of the integrity of its wall with hemorrhage. On the cystogram, the contours of the bladder are not changed. When the pelvic bones are fractured, there is often an extensive hematoma inside bony pelvis, which leads to a displacement of the bubble either upward or to the side. Treatment in such cases is conservative, since the disorder resolves without deformation of the bladder wall.

Intraperitoneal bladder rupture

This injury results from trauma to the abdomen or pelvis while the bladder is filled with urine; in this case, the dome of the bladder ruptures with urine leaking into the abdominal cavity. The cystogram shows extravasation of contrast along the colon and between intestinal loops. A revision of the abdominal cavity is necessary to eliminate the rupture of the dome of the bladder.

Extraperitoneal bladder rupture

The cystogram shows the flow of contrast along the side wall of the pelvis and below the bladder. It is most advisable to obtain a radiograph after lavage of the bladder if extravasation occurs predominantly behind the bladder and the picture is unclear on the cystogram when the bladder is full. Until recently, in such cases, exploration was carried out with the elimination of the extraperitoneal rupture. However, for a single extraperitoneal rupture and minor extravasation, catheter drainage of the bladder (only) has been successful. The catheter is left in place for 14 days; Before its removal, repeat cystography is performed.

Damage to the urethra

There are injuries to the posterior (prostate-membranous) and anterior (bulbous and spongy) parts of the urethra.

Damage to the posterior urethra

Injuries to the posterior urethra are usually associated with a pelvic fracture, whereas injuries anterior section are the result of a direct blow (falling on sharp objects with legs spread wide apart, falling face down). A digital rectal examination and examination of the perineum reveals a perineal hematoma or highly mixed prostate gland, indicating a complete rupture of the urethra. Examination of the perineum reveals the classic “butterfly mottle” caused by a hematoma that is limited to the insertion of the fascia lata.

In the case of a complete rupture in the posterior part of the urethra, there are conflicting opinions regarding the advisability of primary restoration of the integrity of the urethra with suprapubic cystostomy; some clinicians limit themselves to suprapubic cystostomy. In initial urethral repair, the bladder is left open and the urethra is sutured using the "railroad coupling technique" (using two linked probes to pull a Foley catheter into the bladder). When the catheter is pulled up, the ends of the ruptured urethra are brought closer together.

Healing of the urethra occurs over several weeks. If only cystostomy is used. then the pelvic hematoma resolves, allowing the prostate gland to return to its normal position. With both methods, the urethra heals, but with the formation of a stricture; the frequency of impotence and urinary incontinence is the same in both cases.

Urethral contusion

In such cases, there is bleeding from the external opening of the urethra, while the urethrogram remains normal. Urethral contusion is treated conservatively with (or without) a catheter.

Partial urethral rupture

The urethrogram shows limited extravasation of contrast at the site of injury with passage of contrast into the bladder. When treating partial tears, either only urethral catheterization(performed by a urologist), or catheterization in combination with suprapubic cystostomy. Healing occurs over several weeks.

Complete urethral rupture

The urethrogram reveals significant extravasation of contrast at the site of injury in the absence of passage of the contrast agent into the bladder. This damage is repaired surgically in the anterior part of the urethra: suprapubic drainage is performed through a catheter, an epicystostomy is applied to drain urine, and a small urethral dilator is used to immobilize the anastomotic area.

Damage to the genitals

Testicles

Testicular mobility, contraction of the levator testis muscle, and the presence of a strong testicular capsule contribute to the infrequent occurrence of testicular injury in motor vehicle accidents. A direct blow pressing the testicle against the pubic symphysis leads to damage - bruise or rupture. In both cases, the tunica vaginalis sac fills with blood (hematocele), resulting in a large, tense, bluish swelling of the scrotum. Early revision with evacuation of blood clots and suturing of testicular rupture contributes to a more rapid normalization of testicular function than is observed with conservative treatment; however, complications such as hematoma infection and testicular atrophy are less common.

The uncovered testicle should be covered with the remaining skin, even if during reconstruction there is tension in the suture area. Usually the scrotum acquires its almost normal sizes after a few months.

Penis

Self-harm injuries include vacuum cleaner injuries and blade cuts. Using a vacuum cleaner, extensive damage is caused to the glans penis, as well as the urethra, which requires excision of dead tissue and reconstruction. Blade cuts vary from superficial wounds preputial sac until complete amputation of the glans penis. When amputating the penis, replantation or local reconstruction of the external urethral opening is performed. If there is a distal part of the penis, good condition tissues and ischemia duration less than 18 hours, replantation is preferable.

A traumatic rupture of the corpus cavernosum or a fracture of the penis occurs when a member in a state of erection hits a hard object (the symphysis pubis or pelvic floor sexual partner), as well as when applying a direct blow to the penis or when it is excessively bent. At this moment, a crepitating sound is heard, then pain appears in the penis; Swelling quickly increases, skin color changes, and curvature of the penis occurs. With such injuries, immediate surgery is necessary to remove blood clots and restore the integrity of the damaged tunica albuginea corpus cavernosum.

Restoration of skin lost during avulsion or as a result of a burn is carried out by transplanting split flaps onto a cleaned and uninfected wound of the penis. Torn skin should not be sutured back to its original place, as it will inevitably become infected and necrotic; subsequently it has to be removed.

Damage to the penis also occurs when the skin of the preputial sac gets caught in the zipper of the trousers. Manipulations on the snake to remove the skin are usually lengthy and painful. In this case, it is better to use wire cutters to separate the middle link (or lock) of the snake, which will free the pinched skin. Tourniquet syndrome of the penis due to compression or compression, for example by a hair, ring, steel washer or metal nut, is manifested by early onset of pain and swelling of the glans. The compressive object must be removed or cut.

Summary

Trauma to the genitourinary system significantly complicates the treatment of patients with multiple injuries. The ED physician must be knowledgeable about radiological techniques that help determine damage, as well as possible options treatment. The use of CT scanning in the assessment of retroperitoneal damage is becoming increasingly widespread, displacing HSV. However, in cases where rapid assessment of renal function is required, intravenous pyelography remains indispensable.

A. S. Kess, K. S. Smith

Bladder injuries can be open or closed. In peacetime, closed injuries of the bladder are much more common, which are divided into extra- and intraperitoneal (Fig. 12.4).

The degree of such damage can be different: bruise, incomplete (non-penetrating) or complete (penetrating) damage to the bladder wall, separation of the bladder from the urethra. Among closed damage(ruptures) of the bladder are divided into simple (extra- or intraperitoneal), mixed (a combination of intra- and extraperitoneal ruptures), combined (combined with fractures of the pelvic bones or with injuries to other organs) and complicated (shock, peritonitis, etc.) injuries.

Closed bladder injury is most often observed with a direct blow to the suprapubic area. A predisposing condition is bladder overflow with urine. Extraperitoneal rupture of the bladder most often occurs when the pelvic bones are fractured as a result of tension of the vesicopelvic ligaments or damage from bone fragments. Intraperitoneal rupture of the bladder occurs when the bladder is full due to bruise or pressure on the anterior abdominal wall.

Rice. 12.4. Bladder damage:

A -extraperitoneal rupture;b -intraperitoneal rupture

Damage to the bladder can also be iatrogenic, associated with instrumental manipulations (cystoscopy, cystolithotripsy, catheterization of the bladder with a metal catheter), with surgical intervention (laparotomy, hernia repair, etc.).

Symptoms and clinical course. Symptoms of closed bladder injury are pain above the pubis, urinary disturbances, hematuria and signs of urine leakage into the peri-vesical and pelvic tissue (urinary leakage) or the abdominal cavity (peritonitis). When a patient presents late with an extraperitoneal rupture of the bladder, which occurs with continued urination, on the anterior abdominal wall in the symphysis area, in groin areas, redness and swelling may appear on the inner thighs as a result of the development of urinary leaks and the inflammatory process.

Extraperitoneal ruptures of the bladder are usually accompanied by pain in the suprapubic region, urinary retention, and frequent urge to urinate. The pain is diffuse in nature, it is constant, intensifies with the urge to urinate, especially when straining. Sometimes the pain radiates to the perineum, rectum, or penis.

With extraperitoneal closed damage to the bladder, a false urge to urinate is characteristic, accompanied by painful tenesmus and the release of a small amount of blood-stained urine or blood. On palpation, tension is determined abdominal wall above the pubis and dullness percussion sound lower abdomen.

The urination disorder is explained by the emptying of the bladder into the paravesical space through a defect in its wall. As the paravesical hematoma increases, pain in the lower abdomen appears and intensifies over time, radiating to the perineum and external genitalia, tension in the abdominal wall above the pubis appears, and a dull sound without clear boundaries is detected by percussion, spreading to the groin area. With the addition of infection, urinary phlegmon and urosepsis develop.

Hematuria with damage to the bladder is often observed, but is not a constant sign. More intense bleeding is observed when the wound is localized in the neck and bottom of the bladder. Injury to the anterior wall or apex of the bladder is usually not accompanied by severe hematuria. The absence of hematuria does not exclude the possibility of bladder rupture.

With intraperitoneal ruptures of the bladder, victims are often in a state of shock or collapse in the first hours after the injury. The most common and early symptom is pain, which is first localized in the suprapubic region, and then spreads throughout the abdomen and is diffuse (rarely cramping) in nature.

One of common symptoms intraperitoneal ruptures of the bladder - impaired urination with frequent and false urge to urinate. In such patients, urine enters the abdominal cavity through a defect in the wall of the bladder.

Retention of urination against the background of increasing peritonitis is a more reliable symptom of intraperitoneal rupture of the bladder. Already in the first hours after the injury, the abdomen becomes tense, later it becomes swollen and sharply painful due to the development of peritonitis. Over time, as a result of increasing urinary intoxication, the victim becomes lethargic and adynamic. Due to the accumulation of fluid in the abdominal cavity, the abdomen swells, the percussion sound above the pubis and in its sloping parts becomes dull, and a positive Shchetkin sign is noted. Dullness of percussion sound above the pubis is also observed with the formation of a hematoma. During digital examination through the rectum, overhang of the rectovesical muscle can be detected.

Diagnostics. Damage to the bladder is diagnosed based on medical history, instrumental and X-ray examinations. When collecting anamnesis, it is necessary to identify the mechanism of injury (blow to the stomach, car injury, fall from a height, etc.). An objective examination can determine dullness of percussion sound over the pubis, pain on palpation, and symptoms of peritoneal irritation.

Sometimes bladder damage is only suspected during diagnostic catheterization. In case of extraperitoneal ruptures, urine either does not flow through the catheter, or a small amount is released in a weak stream mixed with blood. With intraperitoneal ruptures, when the catheter passes through a defect in the wall of the bladder into the abdominal cavity, a large amount of fluid containing up to 10% protein or more can be released.

One of the main methods for diagnosing bladder rupture is ascending cystography, which allows one to determine the location and shape of the rupture, and the location of bone fragments (Fig. 12.5, a).

With the help of cystography, it is possible to distinguish non-penetrating bladder ruptures from penetrating ones and avoid unnecessary surgical interventions, differentiate extraperitoneal injuries from intraperitoneal ones (the accumulation of a liquid radiopaque substance in the peri-vesical tissue is a sign of an extraperitoneal rupture, and in the abdominal cavity - an intraperitoneal rupture); identify the location of urinary leaks and, approximately, the localization of ruptures (Fig. 12.5, b).

If it is not possible to pass a catheter through the urethra, then it is necessary to perform excretory or infusion urography. In case of shock, when the excretory function of the kidneys decreases, excretory urography is contraindicated.

Treatment. For closed bladder injuries, treatment should be early and comprehensive.

For non-penetrating closed bladder injuries, treatment is conservative. If there is a danger of a complete rupture, strict bed rest is prescribed for 5-8 days, cold compresses on the abdomen, hemostatic and anti-inflammatory therapy, and, if necessary, painkillers.

If there is difficulty urinating or urinary retention, it is necessary to install a bladder irrigation system with an antiseptic solution for 5-8 days.

Rice. 12.5. Ascending cystograms:

A -extraperitoneal rupture of the bladder;b -intraperitoneal bladder rupture

Patients with complete closed bladder injuries are treated only with surgical methods. If a ruptured bladder is suspected, the victim is urgently hospitalized and, after short preparation, is operated on. The extent of surgical intervention depends on the severity of the injury, the nature of the damage to the bladder, the individual characteristics and general condition of the patient.

In case of intraperitoneal ruptures, a laparotomy is performed, a revision of the abdominal cavity is performed, the location of the damage is determined, the bladder is sutured with a double-row catgut suture and the urinary leaks are drained. After laparotomy, the abdominal cavity is thoroughly drained and the abdominal and pelvic organs are examined. The operation is completed with drainage of the bladder (installation of a bladder irrigation system for 6-8 days, less often - epicystostomy).

In case of extraperitoneal rupture of the bladder, its anterior wall is isolated extraperitoneally through a median incision between the pubis and the navel, the bladder is inspected, and the defect is sutured. The operation is completed by draining the bladder (epicystostomy). In case of urinary leakage, the pelvic tissue is also drained according to Buyalsky-McWhorter through the obturator foramina.

When the neck of the bladder is separated from the urethra, after a thorough inspection of the walls of the bladder and the internal opening of the urethra, the neck of the bladder is pulled to the urethra using a Foley catheter (with an inflatable balloon) and the urethra is sewn to the neck of the bladder with a double-row catgut suture. The operation is completed with epicystostomy, drainage of the prevesical and pelvic tissue.

It is not uncommon for a person to experience bladder injuries. The internal organ may rupture or partially damage the integrity of its walls and muscles. There is a problem with various reasons, sometimes even due to a minor bruise, the bladder can burst. Injury internal organ varies in types and forms.

Main types

Combined injury to the bladder and urethra occurs in accidents or other serious situations. In this case, a hematoma often occurs in the abdominal organs.

Forms of defeat

Extraperitoneal and intraperitoneal injuries

Bladder contusion is divided into several forms, each of which differs in location relative to the abdominal cavity. There are 3 forms:

The second type of organ rupture occurs when the peritoneum is damaged.

Extraperitoneal rupture of the bladder. In this case, the organ ruptures in front or on the side of the peritoneum due to injury to the pelvic bones. When the bladder ruptures, it completely empties. All urine flows into soft fabrics, which are located near the organ.
Intraperitoneal. In the event of an intra-abdominal injury, the organ will rupture in the upper or posterior part of the abdomen. With such a lesion, the integrity of the abdominal cavity is also damaged, resulting in an intraperitoneal breakthrough.
Combined. This form of injury urinary organ observed in patients with pelvic fractures. The injury leads to multiple ruptures in different places. In this case, urine is poured into the peritoneum and pelvis.

Partial and complete rupture

It is customary to categorize bladder injuries based on their severity. Some patients experience a minor bruise or stretching of the bladder, which soon goes away on their own. In others, the injury leads to partial or complete rupture of the organ. At partial rupture incomplete damage to the integrity of the walls is noted. Complete defeat indicates that the bladder has completely ruptured and its walls are largely destroyed.

Main reasons

The integrity of the bladder walls is damaged when various injuries, applied to the peritoneal area. If the organ is not affected external factors, then it is reliably protected by the pelvic bones. Injuries often occur when the bladder is full, because if the organ is emptied, it requires very swipe to damage the integrity of the bubble. Highlight following reasons bladder damage:

If you jump incorrectly without first emptying the bubble, it may burst.

Wrong jump. Injury occurs only if the bladder is heavily filled with urine.
Falling down. Damage often occurs when falling from a height onto a hard surface. In this case, not only the bladder is noted to burst, but also other internal organs.
Gunshot or stab wound.
Strong blow to lower zone peritoneum.
Surgery or medical procedures:
- installation of a catheter for diseases of the urinary system;
- dilatation of the urethra;
Surgical intervention on organs localized in the pelvis.
Not emptying the bladder on time due to alcohol intoxication.
Pathologies in the body:
- tumors in the pelvis or nearby localized organs;
- compression of the urethra.

In men, damage to the bladder wall can occur due to pathological growth prostate tissue.
Characteristic symptoms
At closed injuries a person feels pathological symptoms only after a few hours, or even days. This is due to the fact that the patient is in a state of shock, in which painful feelings are dulled. If the bladder ruptures, the person will feel following symptoms:

A rapid pulse may be a symptom of organ injury.
improper excretion of urine, in which it will be problematic for a person to go to the toilet on his own;
blood in urine;
frequent trips to the toilet if the urethra is damaged along with the bladder;
decreased blood pressure due to heavy bleeding;
rapid pulse;
paleness of the skin.

If the patient's bladder ruptures inside the peritoneum, then symptoms resembling peritonitis are noted:
painful sensations of a sharp nature, which intensify when taking a lying position;
temperature increase;
bloating and nausea;
tension of the abdominal muscles.

Extraperitoneal trauma is not characterized by signs of peritonitis; it is manifested by other symptoms:
swelling in the groin and pubic area;
hematoma in the lower part of the peritoneum.

Consequences
If a woman or man's bladder bursts, they will need to immediately seek help from a doctor, since such an injury is fraught with serious consequences:
If the patient is not immediately helped, he will develop shock.
Heavy bleeding And state of shock. With this complication, the patient’s pulse quickens and blood pressure levels rapidly drop. If treatment is delayed, the patient may die.
Attachment of infection. Occurs in the peritoneum open wound, in which pathogenic microorganisms easily enter the blood fluid.
Inflammation in the affected area.
Formation of a pathological channel. This complication occurs if the bladder bursts and a purulent-inflammatory process develops. In this case, you will be injured skin covering and a channel is formed through which microorganisms penetrate into neighboring organs.
Violation bone tissue. When the bladder is injured and subsequently ruptures, an inflammatory and infectious process develops in the bone tissue of the pelvic organs.