Rupture of urinary bladder: a case report and review of literature

Abstract

IntroductionSpontaneous rupture of the urinary bladder is a rare event. Patients usually present with features of peritonitis and diagnosis is usually made at operation. The morbidity and mortality rate is very high in these groups of patients.Case presentationWe present a case of a 47-year-old caucasian woman who was known to have transitional cell carcinoma of the urinary bladder who presented with features of peritonitis. An exploratory laparotomy revealed free perforation of the urinary bladder. The perforation was closed. However, on the second post-operative day she started draining urine from the abdominal drain and was taken back to the operating theatre. The stitches in the urinary bladder had given off and she underwent radical cystectomy along with double barrel cutaneous ureterostomies. Peritoneal biopsies revealed disseminated transitional cell carcinoma in the peritoneum. She made a slow postoperative recovery.ConclusionPerforation of the urinary bladder should be considered in patients presenting with peritonitis particularly with a previous history of urinary bladder cancer.

Spontaneous rupture of the bladder during vomiting

“…The most common cause of urinary bladder perforation is damage to the urinary bladder wall during massive abdominal trauma or iatrogenic, endoscopic excision of bladder tumours or bladder stones, during gynaecological and general surgical interventions. Other less common risk factors include bladder malignancy,2 diverticulum,4 cystitis,3 5 6 pelvic irradiation,7 diabetes mellitus,8 neuropathic bladder,9 alcohol excess,10 postpartum11 and chronic urinary outflow obstruction 12. Those cases that cannot be attributed to one of these are considered idiopathic, such as the patient reported here.…”

Urosepsis complicated by a spontaneous bladder perforation

“…Neoplasms, for example, transitional cell and squamous cell carcinomas may also lead to bladder rupture from tumour necrosis and ulceration 8–10 13. Intravesicular bladder neck obstruction from calculi or papillomas may cause increased pressure and spontaneous rupture 12…”

“…Chest and abdominal x-rays may not reveal pneumoperitoneum or intestinal obstruction 10. Cystogram has been useful to prove the diagnosis but may be falsely negative if the perforation has sealed with surrounding tissues for example, omentum or blood clots 1 2 5 7 10 11. Ultrasound may show fluid collections in the abdomen.…”

Spontaneous bladder perforation unrelated to trauma or surgery

“…Bladder perforations can be extraperitoneal or intraperitoneal, with the latter requiring prompt abdominal exploration and repair. Typically, patients with intraperitoneal bladder perforation present with lower abdominal pain and symptoms including haematuria, dysuria and anuria 1. The abdominal discomfort is generally accompanied by distension, scattered abdominal pain, urinary retention and oliguria following bladder catheterisation 2.…”