Elevated Serum Creatinine Levels Can be a Novel Prognostic Parameter in Patients with Extra Peritoneal Bladder Rupture due to Blunt Trauma: A Report of Two Cases

Keisuke Ymamoto, Motoo Fujita and Shigeki Kushimoto

Osaki City Hospital Emergency Center, Japan
Tohoku University Hospital Emergency Center, Japan
Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Japan

^*Correspondance to: Motoo Fujita 

 PDF  Full Text DOI: 10.25107/2474-1647.1970

Abstract

Introduction: Non-operative management is the standard approach to extra peritoneal bladder rupture and urethral catheter drainage is usually effective. However, surgical treatment may be considered in selected patients to shorten the treatment period and reduce complications. However, no reliable clinical indicator has been developed to help determine the optimal management strategy. We report two cases of extra peritoneal bladder rupture due to Blunt trauma with persistent mild elevation of serum creatinine and mild pseudo-acute kidney injury during the prolonged period of non-operative management.Case
Presentation: Case 1: A 76-year-old woman was diagnosed with a pelvic fracture and multiple traumatic injuries after being hit by a car. Her circulatory status was stable. Extra peritoneal bladder rupture was diagnosed by Computed Tomography (CT) cystography on day 5. We elected nonoperative management and continued bladder drainage through the urethral catheter until day 72. Case 2: A 53-year-old man was hit by a car while riding his motorcycle. He suffered a pelvic fracture, which required embolization of the bilateral internal iliac arteries. A CT scan on day 3 showed leakage of contrast material near the pubis and he was diagnosed with extra peritoneal bladder rupture. He required bladder drainage until the leakage resolved on day 68. In both cases, a mild elevation of serum creatinine was present, which only decreased after the improvement of urinary extravasation from the bladder to the retroperitoneal space.Conclusion: Serum creatinine levels may be a novel parameter to assess the status of extra peritoneal bladder rupture. Mild elevation of serum creatine may be an important indicator in determining the timing of surgery and bladder contrast examination during non-operative management of patients with extra peritoneal bladder rupture.

Keywords

Extra peritoneal bladder rupture; Blunt trauma; Pseudo-acute kidney injury

Cite the article

Ymamoto K, Fujita M, Kushimoto S. Elevated Serum Creatinine Levels Can be a Novel Prognostic Parameter in Patients with Extra Peritoneal Bladder Rupture due to Blunt Trauma: A Report of Two Cases. Clin Surg. 2018; 3: 1970.