Biochemical predictors for differentiating intraperitoneal and extraperitoneal bladder perforation

Purpose: A retrospective clinical study was performed to find out whether s erum biochemistry alterations may serve to differentiate the traumatic blad der perforation to be either intraperitoneal or extraperitoneal. Methods: Thirty-two children treated for traumatic bladder perforation betw een 1970 and 1997, inclusive, formed the study group. Patients were divided into two groups: intraperitoneal bladder perforation (IBP) and extraperito neal bladder perforation (EBP) groups. The groups were compared with regard to age, sex, mechanism of injury, and hemodynamic parameters (blood pressu re, hematocrit) at presentation teach group was further subdivided into two subgroups according to the duration between trauma and presentation as ear ly (duration <24 hours) and late (duration >24 hours) presentation groups). The subgroups were compared with each other with respect to serum concentr ations of urea, creatinine, sodium, potassium, and chloride. Results: There were 21 boys and 11 girls with a mean age of 8.7 +/- 4.9 yea rs. Mechanisms of injury were motor vehicle accidents (75%), falls (19%), a nd gunshot wounds (6%). There was no significant difference between the IBP and EBP groups with regard to age, sex, mechanism of injury and hemodynami c parameters at presentation. The biochemical parameters were found to be w ithin normal range in the EBP group, whereas significantly higher levels of creatinine, potassium, and lower level of sodium were noted in IBP group r egardless of presentation time. Significantly higher level of serum urea wa s recorded in a late presentation group of IBP patients. Conclusions: The authors emphasize that patients presenting with IBP are mo re likely to present with significantly higher levels of creatinine, potass ium, and lower level of sodium compared with the patients with EBP regard l ess of presentation time. Increased lever of serum urea concentration is a characteristic of IBP patients with late presentation. Biochemical alterati ons can be used to differentiate traumatic IBP and EBP in children with sub tle physical examination and radiological findings. J Pediatr Surg 34:367-3 69. Copyright (C) 1999 by W.B. Saunders Company.