Spontaneous rupture of urinary bladder diverticulum with pseudo-acute renal failure

Abstract

A 36-year-old woman presented to the emergency department (ED) with sudden onset, post-micturition lower severe abdominal pain of 1 day duration. She had a history of left thyroid nodules and anemia of chronic disorder, but without any surgical history. There were no other associated symptoms such as chills, nausea, vomiting, diarrhea, constipation or hematuria. She also denied pregnancy, trauma or alcohol consumption.On examination, she was fully conscious, and her vital signs were body temperature of 37.7 °C, pulse rate of 100 beats per minute, blood pressure of 121/84 mmHg, respiratory rate of 20 breaths per minute and the oxygen saturation 99% on room air. Her abdomen was distended with diffuse rebound tenderness and hypoactive bowel sounds. The remainder of her systematic examination was unremarkable.Results of biochemical analysis showed elevated serum levels of urea nitrogen (UN) and creatinine, indicative of acute renal failure (Table 1). Other laboratory examinations, including hemogram, urinalysis and coagulation test, were within the normal ranges. Ultrasound of the abdomen demonstrated ascites and mild distended urinary bladder without hydronephrosis. Diagnostic abdominal paracentesis confirmed the presence of transudative ascites with serum-ascites albumin gradient (SAAG) value greater than 3. Additionally, spontaneous peritonitis was excluded based on normal ascitic fluid polymorphonuclear leukocyte count. Non-contrast computed tomography (CT) of the abdomen and pelvis revealed urinary bladder diverticulum with peritoneal fluid accumulation, which suggested urinary leakage. We prescribed antibiotics and inserted a Foley catheter. Notably, the abdominal distension and tenderness began to resolve, and the serum urea nitrogen and creatinine levels dramatically decreased to a normal range within 16 h (Table 1), which indicated the possibility of ruptured urinary bladder causing urinary ascites and peritoneal irritation. A CT cystography showed extravasation of contrast into the peritoneal space and confirmed the diagnosis of ruptured urinary bladder diverticulum (Fig. 1). The urologist performed a cystoscopy and laparoscopic diverticulectomy after admission and identified a 5 × 5 cm diverticulum at the left lateral wall near the bladder dome intraoperatively. The patient was discharged home on postoperative day 5 uneventfully. DiscussionSpontaneous or non-traumatic rupture of the urinary bladder is a rare, but potentially life-threatening event in adult patients. This condition is associated with certain specific predisposing factors including binge alcohol drinking, pregnancy, infection, neurologic bladder, diabetes, benign prostatic hyperplasia and postpartum complications [1]. Nevertheless, rupture of a urinary bladder from diverticulum is extremely rare, and only few cases have been reported in the literature [2]. The etiologies of urinary bladder diverticulum rupture may originate from congenital anatomic abnormality of pathological urinary bladder wall weakness, but the majority are acquired, inc...

An interesting presentation of invasive bladder carcinoma as pseudo renal failure

“…In adulthood, the commonest cause of such a presentation is the delayed diagnosis of a spontaneous or traumatic bladder perforation. [6][7][8][9][10] Bladder cancer is one such rare cause of spontaneous bladder perforation that can lead to this clinical picture. [11][12][13][14][15][16][17][18][19] Interestingly, most of the cases of bladder cancer who had spontaneous bladder perforations were in fact, squamous cell carcinomas, like our index case, probably denoting more extensive permeation of wall.…”

“…20 Clinicians should distinguish pseudo renal failure from true renal failure based on laboratory analysis of peritoneal fluid, which has higher levels of urea, creatinine, and potassium than serum. [1][2][3][4][5][6][7][8][9][10] Emergency management of these patients depend on the clinical scenario. Unfortunately, most of these patients are elderly and are moribund at presentation, thereby precluding any major definitive surgery like a radical cystectomy.…”

A Rare Case of Acute Urinary Bladder Diverticulitis Mimicking Acute Appendicitis

“…Urinary bladder diverticula are commonly asymptomatic and usually discovered incidentally. Common symptoms related to urinary bladder diverticula include hematuria, urinary tract infections, urinary retention, malignancy, and rarely pain from rupture [ 8 ].…”

Akut Batının Nadir Bir Nedeni: Spontan İntraperitoneal Konjenital Mesane Divertikül Rüptürü

“…4 Bizim olgumuzda da Chih Wei Sung'un da olgusunda olduğu gibi mesane rüptürüne yol açan sebebin altta yatan konjenital mesane divertikülünde gelişen kronik sistit tablosu olabileceği düşünüldü. 2…”

“…Spontan mesane rüptürü genellikle üriner retansiyon, üriner sistem infeksiyonları, mesane içi basıncı arttıran sebepler, travma ya da alkol intoksikasyonu sonrasında görülmektedir. 1,2 Daha nadir olarak foley kateter erozyonu, infl amasyon (eozinofilik sistit, interstisyel sistit) veya dev mesane taşları ilişkili perforasyon görülebilir. 3 Bu olgu sunumunda akut batının nedeni olarak spontan intraperitoneal konjenital mesane divertikül rüptürü tespit edilen bir vakanın tanı ve tedavisi değerlendirildi.…”