pUniversity of Washington, Seattle Cancer Care Alliance, Seattle, Washington. qSpecialty Chair, University of Alabama at Birmingham, Birmingham, Alabama. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Types III and IV bladder injuries can be the result of penetrating pelvic injury. Extraperitoneal rupture represents approximately 60% of major bladder injuries that are due to blunt trauma [3,6]; the incidence of extraperitoneal versus intraperitoneal rupture that is due to penetrating bladder trauma is not known. Sandler et al [7] further subdivided extraperitoneal rupture into 2 groups. With simple extraperitoneal rupture, contrast extravasation is limited to the pelvic extraperitoneal space. With complex extraperitoneal rupture, contrast material extravasation may extend into the anterior abdominal wall, the penis, the scrotum, and the perineum. The presence of a complex extraperitoneal injury implies that the injury has disrupted the fascial boundaries of the pelvis. Such findings should not be mistaken as evidence of a coexisting urethral injury. A combined bladder injury (type IV) results when both intraperitoneal and extraperitoneal bladder injuries are present. Penetrating bladder injuries are typically repaired surgically in the acute setting unless coexisting life-threatening injuries are present [1].
Penetrating Trauma Lower Abdomen and Pelvis. pUniversity of Washington, Seattle Cancer Care Alliance, Seattle, Washington. qSpecialty Chair, University of Alabama at Birmingham, Birmingham, Alabama. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Types III and IV bladder injuries can be the result of penetrating pelvic injury. Extraperitoneal rupture represents approximately 60% of major bladder injuries that are due to blunt trauma [3,6]; the incidence of extraperitoneal versus intraperitoneal rupture that is due to penetrating bladder trauma is not known. Sandler et al [7] further subdivided extraperitoneal rupture into 2 groups. With simple extraperitoneal rupture, contrast extravasation is limited to the pelvic extraperitoneal space. With complex extraperitoneal rupture, contrast material extravasation may extend into the anterior abdominal wall, the penis, the scrotum, and the perineum. The presence of a complex extraperitoneal injury implies that the injury has disrupted the fascial boundaries of the pelvis. Such findings should not be mistaken as evidence of a coexisting urethral injury. A combined bladder injury (type IV) results when both intraperitoneal and extraperitoneal bladder injuries are present. Penetrating bladder injuries are typically repaired surgically in the acute setting unless coexisting life-threatening injuries are present [1].