Traumatic bladder rupture is a rare yet serious injury observed in children who have experienced blunt trauma. Signs include lower abdominal pain, ecchymosis across the abdomen, bloody urine, and the presence of free fluid on abdominal imaging following a high-energy impact. The bladder is a hollow organ and therefore is relatively protected when empty, which makes rupture uncommon. However, in pediatric patients whose pelvic bones are not fully developed, the bladder is more prone to injury. Additionally, when the bladder is full, it can ascend into the abdomen, rendering it more susceptible to damage from blunt forces. To diagnose bladder rupture, CT cystography is the preferred diagnostic test.

Clinical signs of bladder injury are nonspecific. However, if a patient exhibits hematuria (blood in the urine), suprapubic pain, abdominal pain, or experiences difficulty or inability to urinate after a traumatic event, evaluation for bladder injury must be conducted. While routine CT scans of the abdomen and pelvis can differentiate between intraperitoneal and extraperitoneal fluid, they are unreliable for diagnosing bladder rupture since they cannot distinguish urine from ascites (fluid accumulation in the abdominal cavity). Hematuria may be transient or microscopic in cases of bladder injury, and a normal urinalysis does not exclude the possibility of bladder injury. While approximately 80% of patients with bladder rupture have pelvic fractures, bladder ruptures are found in less than 10% of patients with pelvic fractures.

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