Spontaneous perforation of the bladder in a patient operated for a lung abscess: a case report

Abstract

Background: Spontaneous bladder perforation (SBP) is an exceedingly rare, life-threatening event with almost all of the cases reported having a history of previous bladder manipulation, lower urinary tract obstruction, pelvic radiotherapy or surgery, inflammation, and malignancy. There are very few cases in the medical literature about SBP connected with thoracic surgery. Case Summary: We present a rare case of SBP in a female patient who underwent a thoracic operation. A 45-year-old patient was admitted to our department with clinical, laboratory and image findings of a chronic right lung abscess. After right thoracotomy, an upper right bilobectomy was performed. On the day of her discharge, she complained of a sudden abdominal pain, ballooning of the abdomen, nausea and vomiting. The ultrasonography showed a free fluid in the peritoneal cavity. An urgent laparotomy was performed, a perforation of the bladder was found, urologist performed a resection of the necrotic part of the wall and two layer suture of the bladder. Postoperatively, we had multiple complications. Tuberculosis was considered as one of the most likely diagnosis but was subsequently rejected. The patient was discharged after 70 days of hospital stay in a good health condition. Conclusion: SBP can have various underlying causes, and it is exceedingly rare connected with thoracic operations. A general surgeon should always be aware of that condition in the differential diagnosis of the acute abdomen.