If no injury can be found in a patient with frank blood in the rectum, the surgeon must treat the patient as if a rectal injury has occurred. Figure 38 Bladder Injuries of the bladder are usually associated with hematuria, The surgeon should suspect a bladder injury when the entrance or exit wound, the two-plane roentgenograms, or hematuria suggest that this is the case. A cystogram is the definitive test. It is obtained by the instillation of contrast into the bladder via an indwelling urethral catheter. Two roentgen views should be taken, one with the bladder full and the other after voiding.
Extravasation indicates bladder perforation and requires operation.
These injuries should be repaired with two layers of absorbable sutures, insertion of an indwelling suprapubic catheter, and placement of a soft closed-suction drain into the region of the repair. Bladder injuries will heal if the edges of the wound are approximated and adequate bladder decompression is maintained for ten days. Reproductive Organs Conservation should be practiced in the management of injuries of the reproductive organs. Penetrating or crush injuries of the labia, penis, scrotum, and testicles are best treated by conservative debridement and primary repair, if practical. The scrotum should be drained with a soft rubber drain.