Eight-year-old boy presenting with abdominal distention after blunt trauma in Liberia.

To cite: Vinograd AM, Camara AF, Konneh SA, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2016214372 DESCRIPTION An 8-year-old boy presented with abdominal distension 1 week after a wall collapsed on him. Immediately after the injury, he developed abdominal distension. He was treated at an outside hospital and observed overnight. No imaging was available and he was discharged home the following day. His abdominal distension recurred the next day. He presented to another outside hospital and was referred to our institution. Examination was remarkable for abdominal tenderness and distention with neither guarding nor rebound. Ultrasound showed free peritoneal fluid. The differential diagnosis included uroperitoneum, haemoperitoneum, faecal contents due to viscous injury and ascites unrelated to trauma. A bladder catheter was placed and drained 2500 mL of yellow fluid. Repeat ultrasound showed decreased ascites and the appearance of the catheter outside the bladder (figure 1), supporting the diagnosis of an intraperitoneal bladder rupture. Intraoperatively, a bladder laceration was identified and repaired (figure 2). The catheter was maintained for 19 days. The patient was discharged home after successful voiding trials. The bladder is an intra-abdominal organ in children and at higher risk for injury than in adults, where it is protected by the pelvis. Intraperitoneal bladder ruptures occur when a blunt force to the abdomen causes increased intravesicular pressure and bladder dome rupture. Static or CT cystograms are indicated when lower genitourinary trauma is suspected. These are often unavailable in limited-resource settings. Case reports exist documenting recognition of bladder rupture on ultrasound. Although ultrasound is neither as sensitive nor as specific a test, it may play an important role in evaluating such patients in limited-resource settings. Learning points