Is CT cystography an accurate study in the evaluation of spontaneous perforation of augmented bladder in children and adolescents?

Extraluminal contrast was seen on CTC in most cases of SBP, but some patients with sealed bladder perforation had only pneumoperitoneum or moderate/large ascites. Therefore, SBP should be suspected in any patient with moderate/large volumes of pelvic fluid or unexplained pneumoperitoneum, even when there is no evidence of contrast extravasation. Patients with no ascites, or small volumes, are unlikely to have SBP; therefore, US can be used to screen low risk patients.173Figure. CT cystography demonstrating large volumes of ascitic fluid, with no contrast extravasation in a 14-year-old girl who presented with acute generalized abdominal pain, fever, and hematuria. She had a history of myelomeningocele, augmented bladder and Monti and Mace procedures, and two previous bladder perforations. Percutaneous drainage of 800 ml of fluid, which contained creatinine, confirmed the diagnosis of bladder perforation.