Bladder injury should be suspected when trauma is followed by gross hematuria, suprapubic or abdominal pain, and difficulty in voiding or the inability to void. Bladder rupture with blunt abdominal trauma is uncommon; however, because of its high mortality rate, recognition of the early signs and symptoms can be life saving. The most common type of injury is a bladder contusion, which is a diagnosis of exclusion. Extraperitoneal bladder ruptures are almost exclusively associated with a pelvic fracture.