[Intraperitoneal rupture of the bladder in a child].

Rupture of the bladder without injury to the pelvis is largely restricted to adults. The distended bladder of the alcoholic, late at night, is perhaps the most frequent example seen, when relatively minor trauma is sufficient to disrupt the bladder wall, usually intraperitoneally. Extra-peritoneal rupture on the other hand is almost invariably associated with fracture of the pelvis. In most published series the majority of patients are over 40 years of age. In the young it is uncommon and in small children rare. Campbell (I929) published a series of 55 cases in which only three were under ten years old. Bacon (I943), analyzing I47 cases, could find only three under ten, the youngest being five. The youngest recorded was by Brooks (1946) of a child aged three and a half months. Hupp (1925) had one case of two and a half years old and three others of three years old. The following case is therefore thought to be of interest. A boy, aged four and a half, was running up some stone stairs when he slipped and fell down a distance of some eight to ten steps. He appeared to fall on his back, and when his father picked him up he vomited and pointed to the abdomen as the site of pain. He was put to bed and went to sleep. Three hours later he woke up and again cried with pain. He tried to pass water but could not. He was then brought to hospital. When first seen he did not appear shocked. His pulse rate was io8, of good volume, and his temperature was normal. He indicated that his abdomen was painful and although it was slightly tender all over to palpation there was no rigidity. Bruising was evident in both loins and across the back. A drop of blood was seen at the tip of the penis. It was first thought that he had fractured the pelvis and ruptured the urethra, but an X-ray showed no bone injury. A soft rubber catheter passed easily into the bladder when 6 oz. of smoky urine were obtained. This, in conjunction with bruising of the back and loins, supprted a diagnosis of bruising of the kidneys. However he passed no more urine and six hours later his abdominal pain had increased. Distension and shifting dullness were evident. It was then realized that he had ruptured his bladder. He was …