Spontaneous perforation of an augmented bladder is uncommon but can be fatal, and in people with spinal cord injury the usual abdominal signs may be absent. Any patient with an augmented bladder who presents with abdominal pain, distension, fever or sepsis should be assumed to have a perforation until imaging excludes it. A CT cystogram with adequate bladder filling is more reliable than a plain cystogram.
- Ask about bladder augmentation in any patient with spinal cord injury and sepsis.
- Expect blunted abdominal signs in people with spinal cord injury.
- Request a CT cystogram with adequate filling if perforation is suspected.
- Involve urology early; delayed recognition carries high mortality.
Why it matters
The patient may not feel pain, so the diagnosis depends on the clinician remembering the operation.
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