Urinary bladder rupture

Dr Ian Bickle and Radswiki et al.

Urinary bladder rupture is usually seen in the context of significant trauma.

Bladder rupture can be categorized into five types depending on the location and extent of the rupture:

This is commonly seen but sometimes not classed as true rupture, since it involves an incomplete tear of the mucosa.

Also known as interstitial rupture, this is rare. It is caused by a tear in the serosal surface.

Occurs in approximately ~15% (range 10-20%) of major bladder injuries, and typically is the result of a direct blow to the already distended bladder. Cystography demonstrates intraperitoneal contrast material around bowel loops, between mesenteric folds and in the paracolic gutters. Treatment is surgical repair.

Extraperitoneal rupture is the most common type of bladder injury, accounting for ~85% (range 80-90%) of cases. It is usually the result of pelvic fractures or penetrating trauma. Cystography reveals a variable path of extravasated contrast material. Treatment is with an indwelling Foley catheter.

Simultaneous intraperitoneal and extraperitoneal injury. Cystography usually demonstrates extravasation patterns that are typical for both types of injury.

Traditional investigation for suspected bladder rupture was carried out with fluoroscopic cystography 3. However, as this is time-consuming and cannot characterize other pelvic structures its use is being gradually superseded by CT cystography.

CT cystography is performed by instilling water-soluble contrast into the bladder through a Foley catheter. It may be combined with standard CT to evaluate the upper tracts. An extraluminal position of a urinary catheter indicates bladder rupture, although, in an underfilled bladder, the tip of the catheter may falsely appear extraluminal.

Appearances vary with the site of injury:

  • bladder contusion
    • normal
  • subserosal bladder rupture
    • elliptical extravasation of contrast around the bladder
  • intraperitoneal
    • usually bladder dome rupture
    • contrast in paracolic gutters and between loops of small bowel
  • extraperitoneal
    • usually at bladder base anterolaterally
    • extraluminal contrast into perivesical space (simple)
    • molar tooth sign
    • extension of extraluminal contrast to the thigh, scrotum or perineum (complex)
  • combined
    • mixed features of intraperitoneal and extraperitoneal rupture

Intraperitoneal rupture requires surgical repair while extraperitoneal injuries are treated conservatively with a bladder catheter. The presence of other renal tract injuries involving the ureters or urethra may require separate intervention.

Share article

Article information

rID: 12756
Synonyms or Alternate Spellings:
  • Urinary bladder ruptures
  • Intraperitoneal bladder rupture
  • Extraperitoneal bladder rupture
  • Rupture of urinary bladder
  • Bladder rupture
  • Intraperitoneal urinary bladder rupture
  • Extraperitoneal urinary bladder rupture
  • Bladder injury

Support Radiopaedia and see fewer ads

Cases and figures

  • Case 1: intraperitoneal rupture on ultrasound
    Drag here to reorder.
  • Case 2: intraperitoneal rupture
    Drag here to reorder.
  • Bladder rupture
    Case 3
    Drag here to reorder.
  • Case 4
    Drag here to reorder.
  • Case 5: intraperitoneal rupture
    Drag here to reorder.
  • Case 6: extraperitoneal bladder rupture
    Drag here to reorder.
  • Case 7: extraperitoneal rupture
    Drag here to reorder.
  • Case 8: intraperitoneal bladder rupture
    Drag here to reorder.
  • Case 9: intraperitoneal bladder rupture
    Drag here to reorder.
  • Case 10: extraperitoneal bladder rupture
    Drag here to reorder.
  • Case 11: extraperitoneal bladder rupture
    Drag here to reorder.
  • Case 12: extraperitoneal
    Drag here to reorder.
  • Case 13: intraperitoneal
    Drag here to reorder.
  • Case 14 - intraperitoneal rupture of cystography
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.