Bladder rupture caused by an intravenous urogram

Abstract

pain, progressive abdominal distension and diÂculty inCase report voiding urine, with or without haematuria. Although ultrasonography and CT are useful, the diagnostic A 67-year-old man being regularly followed for TCC was admitted with lower abdominal pain and dysuria of a procedure of choice is contrast cystography [2]. The management of an intraperitoneal bladder rupture few days' duration. He was catheterized and 300 mL of mildly blood-stained urine was drained. The findings should be surgical and includes exploratory laparotomy, peritoneal lavage and closure of the bladder in two layers from haematological and biochemical investigations were normal and a urine sample was sent for microbiousing absorbable sutures, and perivesical drainage. If the perforation occurs in a bladder diverticulum, it should logical asessment. He had had a partial cystectomy and radiotherapy for a TCC in a diverticulum of the urinary be excised [3]. This is the first reported case of a bladder rupture bladder in 1974. Follow-up cystoscopy revealed a smallcapacity bladder with telangiectatic changes but no secondary to IVU; we believe that rupture of the bladder diverticulum in this patient occurred due to a combirecurrence of the tumour.In view of the frank haematuria at catheterization, an nation of radiation fibrosis and clamping of the urethral IVU was taken with abdominal compression and a clamp on the urethral catheter. As the initial urograms showed mild hydronephrosis on the left side, 40 mg of frusemide was given intravenously to assess the drainage of the left PUJ. Immediately after the IVU, the patient complained of abdominal pain. Examination revealed generalized abdominal tenderness with decreased bowel sounds. A cystogram confirmed an intraperitoneal bladder rupture and left-sided ureteric reflux (Fig. 1). At laparotomy, there was a small-capacity fibrotic urinary bladder with a perforated diverticulum. Diverticulectomy and closure of the urinary bladder in two layers was performed, leaving a suprapubic and an urethral catheter. The suprapubic catheter was removed after 7 days and the urethral catheter 2 weeks later, after cystographic confirmation that the urinary bladder had healed. The patient made an uneventful recovery and is now followed using annual urine cytology.