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This patient was a victim of assault whilst intoxicated the previous night. During the assault he claims he was kicked and punched in the face, chest, and abdomen by multiple attackers. He presented to his community ED early the next morning complaining of chest pain, shortness of breath and abdominal pain, as well as an inability to pass urine.
Chest radiographs demonstrated two left-sided rib fractures without evidence of pneumothorax. Abdominal plain films did not show free air, but because of the patient's peritoneal signs, he was transferred for evaluation by a trauma surgeon.
The patient was stable, alert and oriented at the time of his arrival. A FAST exam was positive for free abdominal fluid and a cystogram demonstrated an obvious intraperitoneal bladder leak. The decision was made to proceed to the OR for an exploratory laparotomy.
A Foley catheter was placed in the OR. Upon entering the peritoneal cavity there was immediate return of clear yellow fluid with an odour of urine. A large defect in the superior aspect of the bladder was seen immediately, a complete exploration of the abdomen was then performed - no further injuries were identified.
The bladder injury was then closely inspected. It was located approximately midway between the ureters, which were both found to be intact. The edges of the defect were viable and did not require debridement. The defect was repaired in two layers, then tested by injecting saline via the Foley catheter. The abdomen was irrigated thoroughly and closed.
The Foley was left in place for five days, at which point, the cystogram was repeated. No leak was seen and the Foley was removed prior to discharge.