About two percent of cases of abdominal operations are allocated to ruptures of the bladder. This organ is rarely damaged due to protection by the pelvic bones.
The bladder is a hollow organ in which urine accumulates after blood purification by the kidneys. The emptying of the bladder occurs by creating pressure with the muscles of the walls of the bladder. At the same time, the urinary canal opens, through which urine is excreted.
The pelvic bones protect the empty organ from damage, but when overflowing, the top of the bladder protrudes beyond the border of the pelvis in an upward direction. This area is vulnerable and may 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 with a cold or firearm, 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, with falls on the stomach.
Bladder rupture can occur with medical interventions. For example, catheterization, cystoscopy, endoscopy can lead to rupture. Sometimes rupture of the bladder occurs during delivery.
The cause of the gap may be an infection, which 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 squeezes the urinary duct and urine accumulates in the bladder, causing stretching, and then rupture of its walls.
Symptoms
Symptoms of rupture of the bladder are divided into closed and open. The first type is manifested:
- bloating;
- urine builds up in the abdominal cavity;
- pain in the lower abdomen, which after a few hours diverges throughout the abdomen;
- blood in the urine;
- urination in small portions;
- after a while, symptoms of peritonitis appear.
With an extraperitoneal rupture of the bladder, hematuria, pain in the pubic zone, urge to urinate are observed.
With the open type of damage to the bladder, pain is observed throughout the abdomen. Due to the appearance of pain, patients note tension of the abdominal muscles, complain of urinary retention. When you try to go to the toilet, pain appears, and a portion of urine is stained with blood.
When the bubble ruptures, the patient feels shock. When injured by fragments, hemorrhage into the pelvic tissue can occur. With such an injury, the doctor removes all the fragments, and also establishes a drainage for the outflow of blood and urine that has fallen into the cavity.
With extraperitoneal ruptures above the pubis, infiltration may occur. After a few days, purulent inflammation appears on the skin, involving the perineal tissue, thighs, scrotum, and lower abdomen in the pathological process. With the development of the disease, there is an increase in symptoms of intoxication. The patient has an increase in body temperature, tachycardia.
Diagnostics
When examining a patient, if there are no injuries, an anamnesis is necessarily collected. From it, the doctor may suggest an organ injury. For example, a man who has a history of chronic prostatitis or who has complained of pain during urination may consult a doctor. This indicates prostatitis, which can lead to trauma to the bladder.
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 and when were carried out. Sometimes the cause of the rupture is improperly performed catheterization of the bladder, some types of diagnosis.
Mandatory appointment of urinalysis. If there is blood in it, a preliminary diagnosis can be made. Finally, rupture of the bladder is detected after instrumental examination methods.
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 bubble, a contrast agent is introduced inside. A few minutes after its use, an x-ray is taken.
By appointment, the patient can perform computed tomography. It allows you to get a three-dimensional image of the organ, as well as see exactly where the damage is located, set the length of the gap.
Types of gaps
Diagnostics allows you to determine the type of gap. It can be intraperitoneal, extraperitoneal, penetrating or combined extraperitoneal and intraperitoneal damage.
With an intraperitoneal rupture of the bladder, 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 enters the cavity is removed. After the operation, the patient walks with a catheter through which outflow of urine from the damaged organ occurs. This is necessary so that all places of damage have time to heal.
With extraperitoneal damage, a gap is observed on the side or at the bottom of the organ. Signs of rupture of the bladder are the appearance of blood in the urine. Typically, this type of injury occurs with an improperly selected catheter.
Sometimes a penetrating wound leads to injury, which requires surgery. In this form, adjacent tissues and organs are usually damaged.
Possible complications
The consequences of rupture of the bladder are similar in different cases. Most often, the injury leads to peritonitis and osteomyelitis. Fistulas are less commonly observed, abscesses are formed, the skin is disturbed.
With a break, internal bleeding occurs. It can lead to a decrease in pressure, increased heart rate. If treatment is not timely, then pathology can lead to death.
Damage to the bladder leads to the penetration of microorganisms into tissues and organs located near the bladder. Due to the development of pathogenic microflora, there are symptoms of inflammation of the pelvic bones, peritonitis, fistula, anemia is increasing. With timely access to a doctor, you can hope for a positive treatment result.
Prevention
Most often, a rupture occurs when injuring the lower abdomen. To avoid damage to the bladder, one 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 soreness occurs during urination.
Treatment methods
There are two types of treatment for bladder rupture: operative and non-operative. Conservative treatment is prescribed for mild bruises, strokes.
An operative method is prescribed if another treatment method does not give the desired result. Surgery is accompanied by an abdominal wall incision through which the site of damage is sutured. A drainage is established next to the affected organ, through which urine and blood flow.
Diet
Gap treatment requires nutritional adjustment. The patient is forbidden to eat fatty, fried, spicy, salty 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 comply with the diet can provoke pain, divergence of sutures, as well as suppuration. To avoid this, it is necessary to strictly monitor nutrition during rehabilitation.
After rupture of the bladder, the healing process lasts about ten days. At this time, the patient is placed a catheter, providing a normal outflow of urine. After the healing of the bladder, the patient can return to his normal lifestyle. Usually after a month people can gradually introduce their favorite dishes into the diet, drink drinks. Two months later, there will be no trace of the gap. After a year, the place of surgical intervention on the surface of the abdomen will be invisible.