In the case of intraperitoneal bladder injury, what is the recommended management?

• A. Observation and follow-up
• B. Placement of a Foley catheter
• C. Suprapubic cystostomy tube placement
• D. Open surgical repair

Answer: (C)

In cases of intraperitoneal bladder injury, the primary concern is the potential for urine to leak into the peritoneal cavity, leading to chemical peritonitis and the risk of infection. Open surgical repair is often considered the definitive management for this type of bladder injury, particularly if there is a significant tear.

When dealing with intraperitoneal bladder injuries, it is essential to repair the bladder wall defect. The standard approach is typically through an open surgical method, where the abdomen is accessed, and the bladder is inspected for injuries. The repair involves suturing the bladder wall, re-establishing the integrity of the bladder, and subsequently ensuring proper drainage through methods like a cystostomy.

While other options such as placement of a Foley catheter can be appropriate in cases of extraperitoneal injuries or minor injuries where urine diversion is adequate, they are not sufficient for a significant intraperitoneal injury. Similarly, observation and follow-up or the placement of a suprapubic cystostomy tube would not address the primary issue of the injury itself adequately.

The option of open surgical repair addresses the need to repair the bladder itself, which is crucial in preventing further complications, making it the recommended management in cases of intraperitoneal bladder