Urinary bladder rupture during voiding cystourethrography

“Bladder rupture is a rare complication of VCUG, and only a few cases were reported. Bladder rupture among healthy children during VCUG is an especially uncommon event.”

“Presented is a case of bladder rupture that occurred during a VCUG in a healthy 9-month-old infant, due to instilled action of dye by high pressure” (emphasis added).

“Some reported complications of VCUG range from urinary discomfort, UTI to bacteremia, as well as bladder rupture.”

The 9-month-old had grade II VUR in the right ureter and grade III VUR in the left ureter. The VCUG went according to plan, but after the patient was tachypneic with a distended and tender abdomen. She was sent to the operating room for exploration and urine, blood clots, and contrast media had to be removed from the peritoneum. Approximately 3-cm long bladder rupture was found.

“To perform a safe VCUG, we should pay attention to some factors such as bladder volume, the patient’s underlying disease, the velocity of the contrast instilled, and catheter size.”

“The bladder volume is different among individuals, and the bladder dome which is the weakest part of bladder can easily be ruptured when excess volume is injected rapidly.”

“In this case, the main causes of bladder rupture are considered to be the use of the Foley catheter instead of a feeding tube, manual injection of contrast media, and the excess volume instilled more than expected volume.”