Ascitic fluid with ammonia odor as a symptom of bladder rupture

Mizumura, Naoto; Imagawa, Atsuo; Kawasaki, Masayasu; Okumura, Satoshi; Toyoda, Sho; Ogawa, Michio

doi:10.1002/ams2.150

Cited by 5 publications

(13 citation statements)

References 7 publications

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“…Clinically, however, these examinations are not indicated for patients presenting with acute abdominal pain unless there are clear indications to suspect a rupture of the bladder . Furthermore, bladder rupture causes an intraperitoneal leakage of urine that results in significant reabsorption of urea and creatinine through the peritoneum . These clinical findings mimic gastrointestinal perforation and intestinal ischemia with acute kidney injury .…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, bladder rupture causes an intraperitoneal leakage of urine that results in significant reabsorption of urea and creatinine through the peritoneum . These clinical findings mimic gastrointestinal perforation and intestinal ischemia with acute kidney injury . Although abdominal CT is the most frequently used tool for diagnosing acute abdominal pain, CT imaging cannot specifically distinguish bladder rupture from gastrointestinal perforation and intestinal ischemia.…”

Section: Introductionmentioning

confidence: 99%

“…Although abdominal CT is the most frequently used tool for diagnosing acute abdominal pain, CT imaging cannot specifically distinguish bladder rupture from gastrointestinal perforation and intestinal ischemia. Therefore, most patients require exploratory laparotomy to confirm the diagnosis . If the diagnosis is made preoperatively, conservative treatment is a safe and effective option …”

Section: Introductionmentioning

confidence: 99%

“…Therefore, most patients require exploratory laparotomy to confirm the diagnosis . If the diagnosis is made preoperatively, conservative treatment is a safe and effective option …”

Section: Introductionmentioning

confidence: 99%

“…We previously reported a case of spontaneous bladder rupture and described the clinical findings that led us to suspect a bladder rupture; these findings included ammonia‐smelling ascites fluid obtained by abdominocentesis, hypervolemic status of the patient, and a near‐water attenuation value of ascites, recognizing that ascites fluid odor and hypervolemic status are only associated with massive ascites . Therefore, we hypothesized that the attenuation value of ascites would be a useful marker to distinguish bladder rupture from gastrointestinal perforation and intestinal ischemia.…”

Section: Introductionmentioning

confidence: 99%

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Non‐traumatic bladder rupture showing less than 10 Hounsfield units of ascites

Mizumura

Okumura

Toyoda

et al. 2016

Acute Medicine & Surgery

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Aim: Bladder ruptures are commonly misdiagnosed as gastrointestinal perforations or intestinal ischemia. If a diagnosis is made preoperatively, conservative treatment is a safe and effective option. We evaluated the validity of using the attenuation value of ascites, measured by non-contrast computed tomography (CT), to identify patients with bladder ruptures.Methods: A retrospective search of our hospital database identified 7 patients with confirmed bladder ruptures between 2007 and 2013. We also enrolled 18 patients with gastrointestinal perforations and 10 patients with intestinal ischemia with detectable ascites on abdominal CT that had undergone emergency exploratory laparotomy between 2007 and 2013. Between-group comparisons of attenuation values of ascites as obtained by non-contrast CT were evaluated.Results: All attenuation values were less than 10 Hounsfield units (HU) in bladder rupture patients. Moreover, the attenuation value of ascites in cases of bladder rupture (median, 5.7; range, 3.1-6.1) was significantly lower than in cases of gastrointestinal perforation (median, 14.7; range, 4.7-25.4) and intestinal ischemia (median, 13.3; range, 6.0-18.1) (P = 0.004 for both comparisons). Conclusion:Bladder rupture mimics gastrointestinal perforation and intestinal ischemia with acute kidney injury. Therefore, the diagnosis of bladder rupture using the attenuation value of ascites on non-contrast CT is both useful and highly significant. We suggest that bladder rupture be considered in the differential diagnosis of patients presenting with acute abdominal pain and attenuation values of ascites of less than 10 Hounsfield units.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Therefore, most patients require exploratory laparotomy to confirm the diagnosis . If the diagnosis is made preoperatively, conservative treatment is a safe and effective option …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Non‐traumatic bladder rupture showing less than 10 Hounsfield units of ascites

Mizumura

Okumura

Toyoda

et al. 2016

Acute Medicine & Surgery

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The diagnostic challenge of non-traumatic bladder rupture: a pictorial essay

Kunichika

Takahama²,

Taguchi³

et al. 2023

Jpn J Radiol

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Non-traumatic bladder rupture (NTBR) is relative rare pathology including spontaneous rupture and iatrogenic injury. As increasing the medical intervention for the pelvic malignancy or elderly population, NTBR will be encountered more frequently. There are few previous studies summarizing the imaging features of NTBR. We reviewed imaging characteristics of 18 previous cases of NTBR experienced. In addition, 3 presentative cases that can be a pitfall to differentiate from NTBR. The aim of this article is to clarify the key CT findings of NTBR and its pitfalls.

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Estimation of Hounsfield unit conversion parameters for pelvic CT images

Kennedy

Dowling

Greer

et al. 2018

Australas Phys Eng Sci Med

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Linear scaling is used to convert raw computed tomography (CT) pixel values into Hounsfield units corresponding to different tissue values. Analysis of a benchmarking study, presented here, where the same CT scan was imported into and then exported from multiple radiotherapy treatment planning systems, found inconsistencies in HU scaling parameter values exported along with the images, particularly when images were exported using the Radiation Therapy Oncology Group format. Several methods of estimating conversion parameters, based on estimating pixel values corresponding to air and water within the image, for pelvic CT images from a large multi-centre trial were compared against original Digital Imaging and Communications in Medicine export parameters. In general using the mean of a sample region at the centroid of the bladder to estimate the value of water was more accurate than using the minimum or maximum or a single value at the centroid. Accuracy of methods of air estimation tested were dependent in part on features of the CT scanners and treatment planning systems, making it difficult to pick one method as superior that was independent of scanner and treatment planning system type. Based on the above analysis, methods for estimating air and water were selected for use in performing linear scaling of a set of pelvic CT images prior to their use in an interpatient image registration application. The selected methods were validated against a more recent and homogeneous dataset. Estimation error was found to be much lower within the validation set.

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Ascitic fluid with ammonia odor as a symptom of bladder rupture

Cited by 5 publications

References 7 publications

Non‐traumatic bladder rupture showing less than 10 Hounsfield units of ascites

Non‐traumatic bladder rupture showing less than 10 Hounsfield units of ascites

The diagnostic challenge of non-traumatic bladder rupture: a pictorial essay

Estimation of Hounsfield unit conversion parameters for pelvic CT images

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