The most frequent causes of bladder trauma are motor vehicle crashes (in which both seat belt compression of the bladder and ejection injuries may be responsible), falls, crush injuries, and blows to the lower abdomen . Sixty percent to 90% (mean, 80%) of patients with bladder injuries due to blunt trauma have associated pelvic fractures , and approximately 25% of intraperitoneal bladder ruptures occur in patients without a pelvic fracture . In our case, there was no pelvic fracture associated to the urinary bladder intraperitoneal rupture. The patient has just lower abdomen contusion during traffic accident. The Société Internationale D’Urologie  classified bladder injury into four types, which do not take into account the length or extent of the bladder wall laceration: type 1 is bladder contusion; type 2 is intraperitoneal rupture; type 3 is extra peritoneal rupture; and type 4 is combined injury. The severity of urinary bladder injuries is graded from 1 to 5 (least to most severe) according to a classification system developed by the Organ Injury Scaling Committee of the American Association for the Surgery of Trauma (AAST) and is called the organ injury scale (OIS) . We think that the first classification is more practical than the second for the radiologists. Our cases were classified in type 2 and type 3 of the Société Internationale D’Urologie classification.
The vesico-cutaneous fistulas are rare. Cases with a traumatic cause by penetrating wound of the gluteal region , calculous , iatrogenic , malformative , and secondary to an abdominal granulomatosis  were reported in the literature. Nevertheless, no traumatic etiology by penetrating wound of the thigh, and moreover by a piece of wood, have been reported, like in our case.
The role of imaging is essential in the diagnosis of vesico-peritoneal and vesico-cutaneous fistulas. CT cystography is equivalent to conventional cystography for detecting the presence or absence of blunt bladder injury. Cystogram and outpatient cystoscopy were imperative in the diagnosis . CT cystography can be performed as an integral part of the CT screening undergone by many blunt trauma patients and, in the vast majority of these patients; it can alleviate the need for a separate conventional cystogram . The role of CT/conventional cystography is undisputed, but for the Doppler ultrasound, it is uncommon. They demonstrate a leakage of contrast into the peritoneal cavity from wall of the bladder. We report the two first cases of vesico-peritoneal and vesico-cutaneous fistulas suspected in Doppler ultrasound, and the wall bladder rupture was confirmed respectively by CT scan and conventional cystography. This diagnosis has been possible on the basis of a new sign (described here for the first time) called a sign of a third inverted ureteral jet: abnormal Doppler signal, simulating a ureteral jet, but pointing from the inside to the outside of the bladder with normal ureteral jets. This sign permit to exclude a partitioned intraperitoneal liquid fluid collection in the first case. This signal can be explained by a direct visualization of the movement of urine. It is important to understand that this flow visualization is not based on the Doppler effect, since the identification of the flow is not based on the measurement of a change in frequency or phase of the signal, but simply on the non-matching of the signal obtained at time T1 and time T2.
In the cases of vesico-cutaneous, ultrasound could show indirect signs evocative of the diagnosis such as: a low replete bladder, contrasting with the time elapsed since the last miction and the edematous infiltration of the cutaneous tissue.
We think that Doppler ultrasound can constitute a non-radiated and non-invasive imaging means in vesico-peritoneal and vesico-cutaneous fistulas diagnosis. This can be extended to all urinary bladder fistulas (vesico-vaginal, vesico-uterine, colovesical). Nevertheless, there is the need to evaluate the semiological value of this new sign on a greater sample. The detection of the fistulous tracts is not often, and the new signs mentioned is not accurate and not certitude diagnostic.
Surgical repair [14, 15] is the first treatment choice of intraperitoneal urinary bladder perforation, but catheter drainage alone can be applicable to minimal iatrogenic injuries . Laparoscopic suture is an advantageous treatment of isolated intraperitoneal bladder rupture. Proactive management reduces infectious complications [15, 17, 18]. We have opted for a surgical care in our case and got a successful response.
The treatment of vesico-cutaneous is based on the setting of an indwelling bladder catheter with an antibiotherapy  like in our case. The rest of the treatment (pharmaceutical or surgical) will be function of the etiology [8,9,10,12].