INTRODUCTION: Gunshot wounds to the bladder are not uncommon; however it is unusual that a bullet come to rest within the urinary bladder. Properly performed plain film cystography is trusted as a highly sensitive tool for identifying significant bladder injuries due to both blunt and penetrating trauma. Several reports suggest that cystography may be less sensitive in cases of gunshot wounds to the bladder.
METHODS: We report our recent experience with a gunshot wound to the bladder and review the use of cystography in the diagnosis of bladder injury in this setting.
Results: Anecdotal case reports suggest that cystography may fail to identify gunshot injuries to the bladder. No large studies have been performed to evaluate its utility in this unique trauma circumstance.
CONCLUSIONS: Although reliable for the diagnosis of bladder perforation in most trauma settings, cystography may fail to diagnose a penetrating bladder injury due to a gunshot wound. High clinical suspicion based on bullet trajectory, history, and physical exam should guide the workup and treatment of such patients.