Spontaneous puerperal extraperitoneal bladder wall rupture in young woman with diagnostic dilemma

Abstract

A young female presented with an acute abdominal pain and oliguria for 1 week following normal vaginal delivery. No history of hematuria was present. Patient was having lochia rubra. Sealed uterine rupture was suspected clinically. Initial ultrasound of the patient showed distended urinary bladder containing Foley catheter ballon with clamping of Foley catheter and particulate ascites. Abdominal paracentesis revealed hemorrhagic fluid. Contrast-enhanced computed tomography of abdomen revealed ascites, distended urinary bladder and no extraluminal contrast extravasation in delayed scan. As patient condition deteriorated, repeat ultrasound guided abdominal paracentesis was done which revealed transudative peritoneal collection with distended bladder. Cystoscopy revealed urinary bladder ruptures with exudate sealing the rupture site. Exploratory laparotomy was done and a diagnosis of extraperitoneal bladder rupture was confirmed. The rent was repaired in layers. She was put on continuous bladder drainage for 3 weeks followed by bladder training. It presented in a unique way as there was hemorrhagic peritoneal tap, no macroscopic hematuria and urinary bladder was distended in spite of urinary bladder wall rupture which delayed the diagnosis and treatment. Complete emptying of urinary bladder before second stage of labor and during postpartum period with perineal repair is mandatory to prevent urinary bladder rupture.

Spontaneous (idiopathic) rupture of the urinary bladder: a systematic review of case series and reports

“…Once exclusion criteria were applied to the abstracts, 352 studies remained for full‐text review. After again applying the exclusion criteria to the full texts, a total of 278 manuscripts remained and were included in the final review […”

Spontaneous Intraperitoneal Rupture of Bladder Diverticulum: A Rare Cause of Peritonitis

“…When diagnosed, treatment depends on type of bladder rupture as well as the presence of an underlying pathology which may require additional treatment [ 6 ]. Intraperitoneal rupture of a bladder diverticulum requires immediate surgical repair to avoid serious complications, it can be made by laparotomy or laparoscopically in selected patients [ 3 ], and it consists of exploring the whole abdominal cavity, excising the diverticulum, repairing the bladder defect, and draining the abdominal fluid [ 4 , 8 , 13 , 14 ].…”

“…The nonspecificity of its symptoms can delay diagnosis and treatment and can lead to serious complications or even death [ 4 ]. Surgical management remains the standard approach for intraperitoneal bladder rupture [ 2 , 3 , 5 , 6 ]. However, conservative management can be successfully performed in selected patients with favourable characteristics [ 1 , 7 ].…”