Fat-Fluid Intravessical Level: A New Sign of Bladder Rupture

Lipiduria presenting following right hemicolectomy: A case presentation and brief review of the literature

“…Therefore, CT often does not explicitly resolve either the communication between the perinephric lymphatics and the urinary collecting system, or subtle bladder microperforation, which can allow transmural migration of lipolyzed perivesical fat. However, CT provides evidence of these processes when sufficient lipids accumulate to form a fat-fluid level [3] , [11] . Lymphangiography or lymphoscintigraphy has also been attempted with limited success to identify the exact site of a chyle leak [4] , [12] .…”

“…Urine-induced lipolysis is a rare complication in the setting of bladder or renal injury [1] . Lipiduria has been reported as a sign of bladder rupture on both traumatic and iatrogenic bases [2] , [3] , [8] , [9] , [11] , [13] . Martinez-Moya et al [11] speculated that small fatty drops from the extravesical compartment passed through the ruptured bladder wall after blunt abdominal wall trauma.…”

The combined uro-radiological “Rendezvous” procedure, and an unusual CT and cystoscopic finding

“…Martinez-Moya et al report a case of intravesical fat-fluid level secondary to traumatic bladder rupture, which was noted on the patient’s CT imaging at presentation. 10 The proposed mechanism is of acute increase in intra-abdominal pressure leading to migration of small fatty droplets from the extravesical compartment through the ruptured bladder wall. Soussan et al have reported a case of fat-fluid levels demonstrated in the renal calyces following urine extravasation as a complication of high-grade urinary tract obstruction and infection, proposing a mechanism whereby extravasated urine induces lipolysis of perirenal fat, the components of which enter the renal collecting system and collect in the non-dependent position.…”

Lower Urinary Tract Injuries: A Guide for the Emergency Radiologist

“…They have hypothesized that extravesical fat droplets migrated into the intravesical cavity via the rupture as a result of the sudden increase in the intrapelvic pressure. 22 The American Association for the Surgery of Trauma (AAST) have described an organ injury severity scale for bladder trauma. 23 This grading system incorporates the size of bladder wall deficit as well the relationship of the deficit to the bladder wall neck and ureteric orifices.…”

“…In the United States, traumatic injuries constitutes the leading cause of death in people aged 1 to 44 years, with young males (age [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] having the greatest burden of injury. 1 Urologic injuries are typically encountered in patients with multitrauma, as these organs are either well protected within the abdomen and pelvis or physically mobile (penis and testicles).…”