TAILIEUCHUNG - Surgical Therapy of Bladder Rupture

Most, if not all, intraperitoneal bladder ruptures require surgical exploration. These injuries do not heal with prolonged catheterization alone. Urine takes the path of least resistance and continues to leak into the abdominal cavity. This results in urinary ascites, abdominal distention, and electrolyte disturbances. | Surgical Therapy of Bladder Rupture A-Intraperitoneal bladder rupture vỡ bàng quang trong phúc mạc Most if not all intraperitoneal bladder ruptures require surgical exploration. These injuries do not heal with prolonged catheterization alone. Urine takes the path of least resistance and continues to leak into the abdominal cavity. This results in urinary ascites abdominal distention and electrolyte disturbances. Surgically explore all gunshot wounds to the lower abdomen. Because of the nature of associated visceral injuries immediately take patients with high-velocity missile trauma to the operating room where the bladder injuries can be repaired concomitantly with other visceral injuries. Stab wounds to the suprapubic area involving the urinary bladder are managed selectively. Surgically repair obvious intraperitoneal injuries and manage small extraperitoneal injuries expectantly with catheter drainage. B- Extraperitoneal extravasation Bladders with extensive extraperitoneal extravasation often are repaired surgically. Early surgical intervention decreases the length of hospitalization and potential complications while promoting early recovery. C- Preoperative Details Follow the basic trauma protocol advanced trauma life support ATLS and stabilize the patient. Administer broad-spectrum antibiotics and obtain a surgical informed consent if possible. In the setting of emergency trauma however there is often no time for a formal surgical consent from the patient. D- Intraoperative Details Chi tiết phẫu thuật 1- Position the patient in a supine fashion. 2- Create a vertical midline abdominal incision. 3- Conduct a thorough inspection of the pelvic viscera ureters bowel and blood vessels. 4- Note the presence of pelvic hematoma and if present leave undisturbed. 5- Bivalve the dome of the bladder. 6- Inspect the interior of the bladder. Foreign bodies such as bone or orthopedic hardware are often encountered and should be removed. 7- Identify both ureteral orifices and

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