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Recurrent Rupture of the Urinary Bladder 1

Case report A 64-year-old man was admitted, having been run over by a motorbike outside a public house. He was drowsy and smelt strongly of alcohol. Apart from superficial lacerations, the only apparent injury was an extensive fracture of the left parietal bone. The following day he developed generalized abdominal pain, associated with tachycardia and minimal urinary output. The abdomen was tense and bowel sounds were absent. Plain abdominal radiographs showed a 'ground-glass' appearance with separation of small bowel loops. Laparotomy was performed and a large intraperitoneal rupture of the dome of the bladder was repaired with two layers of chromic catgut. A minor capsular tear of the spleen was also noted. Transurethral catheter drainage was continued for 9 days and the patient made an uneventful recovery. Four months after the original injury the patient reappeared in the Accident and Emergency department with mild facial injuries when he tripped over a low fence whilst drunk. Since no other injury was detected, he was discharged but returned two days later complaining of lower abdominal pain. He had not passed urine for two days and had had no desire to do so. On examination the abdomen was general1y tender but the bladder was impalpable. He subsequently developed a paralytic ileus and X-rays again showed a 'ground-glass' appearance. At laparotomy, in addition to multiple adhesions, he was noted to have a further rupture of the bladder through the dome. The site of rupture was in close proximity to the previous injury, although the multiple adhesions obscured the exact position of the scar. The injury was treated as before.