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Clinical pearl: Unexplained ascites after brutal abdominal surgery… : Emergency Medicine News


Following blunt abdominal trauma, peritoneal fluid on a CT scan with no evidence of solid organ damage can be a major diagnostic dilemma. Bladder rupture should be considered if nonhemorrhagic fluid is present in the abdomen on CT with no evidence of solid organ damage, after ruling out preexisting conditions such as cirrhosis or heart failure.

Delayed CT and CT cystography should be considered for further evaluation, as early recognition of bladder injury is crucial for appropriate surgical intervention.

Modern CT scanners scan the abdomen and pelvis within seconds of IV contrast administration, so bladder imaging is usually performed before the contrast is excreted into the renal collecting systems and ureters.

Imaging during the excretion phase is not routinely performed unless urinary tract injury is suspected. Extravasated urine in the peritoneum appears as simple peritoneal fluid when a patient has an intraperitoneal bladder rupture. (priest. 2021;13[12]:e20479;; Chin J Traumatol. 2015;18[6]:357;; Radiology. 2010;256[3]:799.)

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