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Case Reports in Urology
Volume 2015 (2015), Article ID 476043, 4 pages
http://dx.doi.org/10.1155/2015/476043
Case Report

Extraperitoneally Ruptured, Everted, and Prolapsed Bladder: A Very Rare Complication of Pelvic Injury

1Urology Unit, Department of Surgery, College of Medicine, University of Lagos and Lagos University Teaching Hospital, PMB 12003, Idi Araba, Lagos, Nigeria
2Department of Orthopaedics, Lagos University Teaching Hospital, PMB 12003, Idi Araba, Lagos, Nigeria
3Urology Unit, Department of Surgery, Lagos University Teaching Hospital, PMB 12003, Idi Araba, Lagos, Nigeria

Received 25 May 2015; Accepted 20 August 2015

Academic Editor: Giorgio Carmignani

Copyright © 2015 Rufus Wale Ojewola et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Traumatic rupture of the bladder with eversion and protrusion via the perineum is a rare complication of pelvic injury. We present a 36-year-old lady who sustained severe pelvic injury with a bleeding right-sided deep perineal laceration. She had closed reduction of pelvic fracture with pelvic banding and primary closure of perineal laceration at a private hospital. She subsequently had dehiscence of repaired perineal laceration with protrusion of fleshy mass from vulva and leakage of urine per perineum five weeks later. Examination revealed a fleshy mucosa-like mass protruding anteriorly with a bridge of tissue between it and right anterolateral vaginal wall. Upward pressure on this mass revealed the bladder neck and ureteric orifices. She had perineal and pelvic exploration with findings of prolapsed, completely everted bladder wall through a transverse anterior bladder wall rent via the perineum, and an unstable B1 pelvic disruption. She had repair of the ruptured, everted, and prolapsed bladder, double-plate and screw fixation of disrupted pelvis and repair of the pelvic/perineal defect. She commenced physiotherapy and ambulation a week after surgery. Patient now walks normally and is continent of urine. We conclude that the intrinsic urethral continent mechanism plays a significant role in maintaining continence in females.