Urological emergencies: unmasking massive bladder hematomas
Article information
A 53-year-old male patient presented to the emergency department with a history of hematuria 1 day after right inguinal mesh repair. The point-of-care ultrasonographic assessment revealed bladder distention with a heterogeneously hyperechoic intravesical volume of approximately 330 to 350 mL, consistent with hematoma (Fig. 1). Despite bladder irrigation, hematuria persisted. Further evaluation via computed tomography urography identified a substantial intravesical hematoma (Fig. 2) and a discrete defect in the bladder's superolateral wall (Figs. 3, 4), accompanied by an adjacent collection in the right lower abdomen, implying a bladder rupture with an associated hematoma. The intervention entailed surgical evacuation of the hematoma and repair of the bladder wall. Postoperative imaging demonstrated the absence of any residual pathologies, signifying a comprehensive resolution of the initial presentation.
Transverse view of the urinary bladder. Urinary bladder is distended with a heterogeneously hyperechoic collection of approximately 330 to 350 mL suggestive of urinary bladder hematoma.
Axial view of the computed tomography scan. Urinary bladder is distended with hyperdense content measuring 12 × 7 × 9 cm3 and approximately 350 to 380 mL, suggesting intravesical hematoma (arrow).
Axial view of the computed tomography scan, showing urinary bladder defect (arrow).
Coronal view of the computed tomography scan, showing urinary bladder defect (arrow).
Bladder injury is a complication of laparoscopic surgery; its reported incidence is 0.5% in general surgery and 2% in gynecology [1]. This case underscores the pivotal role of emergency medicine in the early diagnosis and management of bladder hematoma in patients presenting with hematuria after surgical procedures. Using point-of-care ultrasound, which is a rapid and noninvasive diagnostic tool, emergency medicine practitioners can promptly identify a bladder hematoma, facilitating timely intervention and optimal patient care.
Ethics statement
Written informed consent for publication of the research details and clinical images was obtained from the patient.
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Author contributions
Conceptualization: all authors; Methodology: all authors; Investigation: all authors; Writing–original draft: AP; Writing–review & editing: all authors; All authors read and approved the final manuscript.
Conflicts of interest
The authors have no conflicts of interest to declare.
Funding
The authors received no financial support for this study.
Data availability
Data sharing is not applicable as no new data were created or analyzed in this study.
References
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Capsule Summary
What is already known
Bladder hematomas, albeit rare, have been described in the medical literature as uncommon postoperative complications, typically resulting from iatrogenic injury during surgery or coagulation disorders. Their clinical manifestations range from urinary retention to life-threatening hemorrhage.
What is new in the current study
The present study discusses an exceptional case of a massive bladder hematoma following hernia surgery, and it details the diagnosis and management of the hematoma. In addition, it provides insights into the use of diagnostic techniques, such as point-of-care ultrasound and computed tomography.