[size=20px]A three-year old restrained passenger in a motor vehicle collision presents with gross hematuria.

 

Which of the following statements is true regarding trauma patients with hematuria?

 

A gross hematuria is an absolute indication for a cystogram

 

B bladder neck laceration is best managed by stenting with a Foley catheter

 

C conventional cystography is the preferred diagnostic tool

 

D seatbelts protect against bladder injury

 

E intraperitoneal bladder rupture is best managed by open exploration[/size]

E

E

correct

 

Bladder rupture is an uncommon injury in the pediatric trauma population. The reported incidence was 0.05% in a series of 1,500 children with blunt abdominal trauma who underwent computerized tomography (CT) scanning with a protocol designed to detect bladder rupture. Gross hematuria is not an indication for bladder imaging unless combined with pelvic fracture or other worrisome clinical indicators. CT cystography has replaced conventional cystography in most trauma centers. The urinary bladder is relatively well protected within the confines of the bony pelvis. However, intraperitoneal rupture is more commonly seen in children.

 

Intraperitoneal rupture has been described in children with a full urinary bladder who sustain seatbelt injuries or nonaccidental trauma. Extraperitoneal rupture is usually associated with a pelvic fracture and can typically be managed with catheter drainage of the bladder. However, if there is extension through the bladder neck, open intravesical repair should be employed. Open surgical repair remains the standard treatment for intraperitoneal bladder rupture although nonoperative treatment has been described in selected cases.