title: Failure of conventional retrograde cystography to detect bladder ruptures in pelvic trauma.
abstract: Conventional retrograde cystography is often used to investigate patients with suspected bladder ruptures in pelvic trauma. Clinical indicators suggestive of a rupture include haematuria and suprapubic tenderness and should increase the suspicion of bladder and urinary tract injury and prompt the clinician to undertake further investigations. Two patients with high-energy pelvic fractures had bladder ruptures detected intraoperatively despite normal preoperative retrograde cystogram. Both patients had significant clinical indicators suggestive of underlying bladder and urinary tract injury. In both cases, a routine conventional retrograde cystogram was performed but failed to identify the full extent of the bladder injury. A possible reason for misdiagnosis in these cases is the delay between injury and investigation due to tertiary referral of care.
authors.affiliation: Department of Trauma and Orthopaedics, St Georges Healthcare NHS Trust, Blackshaw Road, Tooting, London, UK. onurberber@yahoo.co.uk
authors.forename: O
authors.initials: O
authors.lastname: Berber
authors.forename: C
authors.initials: C
authors.lastname: Emeagi
authors.forename: M
authors.initials: M
authors.lastname: Perry
authors.forename: M S
authors.initials: MS
authors.lastname: Rickman
mesh_terms: D000328:Adult; D003951:Diagnostic Errors; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D011631:Pubic Symphysis / Q000000981:diagnostic imaging / Q000293:injuries; D011860:Radiography, Abdominal; D012421:Rupture; D012447:Sacrum / Q000000981:diagnostic imaging / Q000293:injuries; D001743:Urinary Bladder / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000601:surgery; D014546:Urinary Catheterization