DIAGNOSTIC DIFFICULTIES IN PATIENTS WITH A RUPTURED BLADDER

Isolated bladder rupture has an insidious presentation which results i n delayed diagnosis and management. Forty-four patients, of mean age 3 3.3 years, were seen over a period of 7 years. There was a history of trauma in 33 patients, although this was minor in 20. Alcohol intoxica tion, head injury or paraplegia could have led to lack of sensation of the distending and subsequently injured bladder in 18 patients. The m ean delay between an identifiable incident or presentation and diagnos is was 5.4 days. The mean admission or preoperative levels of blood ur ea and creatinine were raised to 19.6 mmol/l and 362 mu mol/l respecti vely in those with a delayed diagnosis. The diagnosis was made by void ing cystourethrography in 36 patients and by laparotomy in eight. When blood urea and creatinine concentrations are increased in a patient w ith an ill-defined abdominal ailment and a history of trauma or drunke nness, ruptured bladder should be considered.