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Two hundred and fifty millilitres of water soluble contrast medium is introduced into the bladder through a Foley catheter and a further 150 ml if the patient does not experience any discomfort. CT cystography is often the most convenient method, as acute trauma patients often have additional indications for CT. Alternatively, fluoroscopy can be used when frontal and lateral views are obtained with images also taken post-void.

Flame-shaped extravasation superior and lateral to the bladder indicate extra-peritoneal rupture (see Fig. 3.30). Intra-peritoneal injury is manifested by contrast throughout the peritoneal cavity, outlining bowel and in the paracolic gutters. Delayed CT imaging may demonstrate bladder rupture and also any associated bony pelvic injuries (see Figs 3.31 and 3.32). It is less sensitive than cystography. The importance of identifying intra-peritoneal rupture is that surgical repair is required acutely. Extra-peritoneal ruptures are treated conservatively with catheter drainage and antibiotics unless a cystogram at 7-10 days demonstrates persistent leakage. 153

Male aged 29. Road traffic accident.

■ What type of fracture

Fig. 3.33 Quiz case.

Male aged 29. Road traffic accident.

■ What type of fracture is demonstrated

■ What are the main complications from pelvic fractures?

Fig. 3.33 Quiz case.

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