A 39-year-old male is brought to the Emergency Department complaining of severe lower abdominal pain and an inability to void. He had been involved in an altercation following a ‘heavy’ drinking session. He vaguely remembers being punched to the head and lower abdomen. He did not lose consciousness and has been assessed as having only a minor head injury. Examination reveals a stable patient with lower abdominal tenderness, but no obvious palpable bladder. Blood and urine tests are normal. What is the investigation would you consider next?A. Intravenous urogram with delayed phase
This patient’s most likely diagnosis is an intraperitoneal bladder rupture from a direct blow to a full bladder. A stress cystogram is the investigation of choice in suspected bladder injuries. However intraperitoneal ruptures will lead to early contrast extravasation so neither the full volume (nor full strength contrast) should be used in these cases in the first instance.