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  • Trauma Vesica L

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    corsaru
    19 vues2 pages
    Bladder trauma represents 2% of abdominal injuries requiring surgery. 67-86% are blunt trauma injuries while 14-33% are penetrating trauma injuries. Over 85% of bladder injuries are further associated with multiple abdominal injuries.

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    Trauma Vesica l

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    Bladder trauma represents 2% of abdominal injuries requiring surgery. 67-86% are blunt trauma injuries while 14-33% are penetrating trauma injuries. Over 85% of bladder injuries are further associated with multiple abdominal injuries.

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    19 vues2 pages

    Trauma Vesica L

    Transféré par

    corsaru
    Bladder trauma represents 2% of abdominal injuries requiring surgery. 67-86% are blunt trauma injuries while 14-33% are penetrating trauma injuries. Over 85% of bladder injuries are further associated with multiple abdominal injuries.

    Droits d'auteur :

    Attribution Non-Commercial (BY-NC)
    Téléchargez comme PDF, TXT ou lisez en ligne sur Scribd
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    sur 2

    Bladdertrauma

    Incidence

    Represents2%ofabdominalinjuriesrequiringsurgery. 6786%areblunttraumainjurieswhile1433%arepenetratingtraumainjuries. Over30%ofpelvicfracturesareassociatedwithbladdertrauma(714%inchildren). Incasesofbladderinjuryduetotrauma,7097%presentaconcomitantpelvicfracture. Over85%ofbladderinjuriesarefurtherassociatedwithmultipleabdominalinjuries. Pubic symphysis diastasis, sacroiliac diastasis, and fractures of the sacrum, iliac, and pubic ramiareallsignificantlyassociatedwithconcomitantbladderrupture. Thecombinationofintraandextraperitonealruptureoccursin220%ofcases.Simultane ousruptureofthebladderandurethra(prostaticmembranous)occursin1029%ofcases.

    Etiology
    Trauma:themostcommoncauseofbladderrupture(90%). Iatrogenictrauma:usuallyduringinfraumbilicalabdominalsurgery. - Abdominal or pelvic surgery(85%):themostcommongynecological(5261%),urologi cal(1239%),andcoloproctologysurgery(926%). - Anteriorvaginalsurgery(9%). - Laparoscopy(6%). Risk factors:drivingundertheinfluenceofalcohol(bladderdistension)andtechniquesof incontinencesurgery(4foldincreaseofrelativerisk).

    AASTclassification(AmericanAssociationfortheSurgeryofTrauma)
    GradeI:intramuralhematomaorpartiallacerationofthebladderwall. GradeII:extraperitoneallacerationofthebladderwall<2cm. GradeIII:extraperitoneallaceration>2cmorintraperitoneallaceration<2cm. GradeIV:intraperitoneallaceration>2cm. GradeV:intraorextraperitoneallacerationaffectingthebladderneckorureteralorifice.

    Diagnosis Cystography:standardprocedure.Mostaccurateradiologicalstudy(85100%)foridentify ingbladderrupture.Imagesshouldbemadeoftheempty,full,andpostvoidbladderinvari ouspositions.Performedwithaninfusionof350mLofdilutedcontrastmedium,filledwith theaidofgravity.Ifaconcomitanturethralinjuryissuspected,aurethrographyshouldbe performedpriortocystography.Dependingonthetypeofinjury: - Intraperitonealrupture:extravasationoutlinestheintestinalloops. - Extraperitonealrupture:flamelikeextravasationoroutsidethelimitsofthepelvis. CystogramCT: 95% sensitivity and 100% specificity. Should be carried out by means of retrogradeinfusionofcontrastmedium(350mL).Allowsevaluationofassociatedinjuries. IVP: detects 15% of all bladder injuries (low bladder pressure hinders detection of small lacerations). Not an adequate examination technique for bladder trauma. A pearshaped bladderisasignofpelvichematoma. Cystoscopy:usefulincasesofiatrogenictraumatodetectunsuspectedlesions(85%accura cy).Shouldbeusedinmajorgynecologicalproceduresandantiincontinencesurgery.

    Symptoms The most common are hematuria (82%) and distension with hypogastric pain (62%). If grosshematuriaandpelvicfracturearepresent,immediatecystographyisindicated. Othersymptoms:inabilitytovoidoraperinealscrotalhematomaduetoextravasation.

    Extraperitoneal rupture:bladderdrainagewiththeaidofFoleycatheter.Surgicalexplora tionisindicatedonlyiftheruptureaffectsthebladderneck,trigone,orifthereareassociat edlesions(vaginaorrectum).Ifunsuccessful,percutaneousdrainagemustbeperformed.In casesofhematuria,largercatheters(2224F)arepreferredforatleastthefirst2weeks. Blunt intraperitoneal rupture or any penetrating trauma: requiressurgicalexploration andrepair. Iatrogenic lesion (endoscopic surgery): if there is only one clean perforation, use of a Foleycatheterandintraperitonealdrainageusuallysolvestheproblem. Broadspectrumantimicrobialspreventinfectionofthehematoma. Surgicaltechnique: - Infraumbilicalincisionandexplorationoftheperitonealcavity. - Openingoftheanteriorsideofthebladder,explorationofthebladderinterior,and threelayerclosureoftherupturewithpolyglactine(VICRYL)orpolyglycolicacid (DEXON):4/0forthemucosaand2/0inthemuscularisandadventitia. - Adequatebladderdrainageviasuprapubicorurethralcatheter.Drainage:48h.

    Treatment

    Bluntbladder injury

    Penetrating bladderinjury

    Nonassociatedinjuries

    Associatedinjuries

    Cystogram

    CystogramCT

    Extraperitoneal bladderrupture

    Intraperitoneal bladderrupture

    Catheter drainage

    Surgical exploration

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