Entrapment of the urinary bladder: A rare mechanism of bladder injury in pelvic trauma

Abstract

A pelvic fracture with entrapment of the urinary bladder in the fracture site is a rare pattern of injury. As the “team captains” in the trauma bay and in the care of polytraumatized patients, trauma surgeons must be aware of this entity and its implications. We report a case of acute bladder entrapment in the fracture site of a lateral compression pelvic fracture. A review of the English literature yielded four previous reports, including two patients with delayed diagnosis (Ghuman et al., 2014; Kumar et al., 1980; Wright and Taitsman, 1996; Min et al., 2010 [1–4]). Kumar and colleagues first documented bladder entrapment by a pelvic fracture in 1980 (Kumar et al., 1980 [2]). Ghuman et al. described a similar case treated with fixation of the pelvic fracture (Ghuman et al., 2014 [1]). Wright and colleagues treated a patient with bladder perforation due to entrapment diagnosed two weeks after a pelvic ring fracture (Wright and Taitsman, 1996 [3]). In this case the bladder injury was repaired, but internal fixation of the pelvis fracture was avoided due to fear of contamination. Finally, Min et al. documented a case of bladder entrapment and perforation presenting six months after non-operative management of a pelvic ring fracture. The female patient developed recurrent UTIs and dyspareunia, and imaging revealed fracture malunion with the bladder entrapped in the fracture site (Min et al., 2010 [4]). This collection of case reports demonstrates the potential for acute or delayed bladder injury even in seemingly benign pelvic fractures. A high index of suspicion is required to intervene and prevent morbidity from bladder injuries in pelvic trauma. Entrapment of the bladder may require surgical intervention even when the injury pattern would not normally dictate surgery for the pelvis or bladder alone (Bryk and Zhao, 2016 [5]). We describe the diagnosis and surgical management of bladder entrapment and present a brief review of bladder injuries associated with pelvic fractures.

Unrecognised entrapment of a herniated bladder at the pubic symphysis following reduction and external fixation of an unstable pelvic fracture

“…Documented incidences of bladder entrapment invariably occur in complex pelvic fractures. Bladder entrapment has been reported to occur with or without pubic symphysis diastasis, as the bladder may become entrapped in the symphysis or in a rami fracture 6–9. Diagnosis of bladder entrapment can pose varying diagnostic challenges and can sometimes be identified on initial trauma CT or cystogram 9.…”

“…Bladder entrapment has been reported to occur with or without pubic symphysis diastasis, as the bladder may become entrapped in the symphysis or in a rami fracture 6–9. Diagnosis of bladder entrapment can pose varying diagnostic challenges and can sometimes be identified on initial trauma CT or cystogram 9. However, instances of delayed diagnosis have been described when patients present with persistent lower urinary tract symptoms 7 10.…”

Imaging of Pelvic and Acetabular Trauma: Part 2, Soft-Tissue Findings

“…During reduction and fixation, the laceration and full extent of the injury is uncovered once the entrapping fragment is moved (Figure 8). [20][21][22] Pelvic fracture-related urethral injury is less common overall but occurs more frequently in male patients. In addition to physical examination findings of blood at the urethral meatus, Foley insertion can be difficult and/or unsuccessful.…”

“…During reduction and fixation, the laceration and full extent of the injury is uncovered once the entrapping fragment is moved (Figure 8). 20–22…”

Bladder incarceration within a displaced pelvic ring nonunion

“…Acute bladder injuries occur in 6 to 15% of pelvis fractures and can alter how the pelvis is managed [ 1 ]. There are multiple reports of bladder entrapment within acute pelvis fractures [ [2] , [3] , [4] ]. We present the interesting case of a lateral compression pelvis injury, initially treated non-operatively which progressed to nonunion with displacement incarcerating the bladder.…”