# Imaging Approach and Diagnosis in a Case of Combined Intraperitoneal: Extraperitoneal Urinary Bladder Injuries in a Child

## TL;DR

A four-year-old child with combined urinary bladder injuries after a road traffic accident was diagnosed using imaging and successfully treated with surgery.

## Contribution

This paper presents a rare case of combined intraperitoneal and extraperitoneal bladder injuries in a child diagnosed using contrast-enhanced CT without retrograde cystography.

## Key findings

- Contrast-enhanced CT scan at delayed phases revealed combined bladder injuries without retrograde cystography.
- Emergency surgical repair led to successful recovery in a four-year-old child.
- The case highlights the rarity of combined intraperitoneal and extraperitoneal bladder injuries in children.

## Abstract

Urinary bladder rupture is a rare injury, both in adults and in children. Urinary bladder rupture in children is often due to road traffic trauma and is mostly of the intraperitoneal variety due to the higher anatomical location of the urinary bladder. Combined, post-traumatic, intraperitoneal, and extraperitoneal injuries, whether in adults or in children, are rare. The patient reported by us is a rare case of combined intra and extraperitoneal injuries in a four-year-old male child, without significant pelvic fractures. The boy, who sustained a road traffic accident a few hours earlier and was brought in a state of shock, with a history of anuria. Focused abdominal sonography for trauma (FAST), in the emergency room, was interpreted as “hemoperitoneum”. Adequate resuscitation and urinary bladder catheterization were followed by a contrast-enhanced CT scan (CECT). The delayed phase of the CECT scan at 30 and 45 minutes, without additional retrograde cystography, revealed the combined intraperitoneal-extraperitoneal injuries of the urinary bladder. Emergency surgery, with repair of the urinary bladder, led to a satisfactory recovery, and the boy was discharged in good condition at the end of three and a half weeks of hospitalization.