Bedside ultrasound diagnosis of atraumatic bladder rupture in an alcohol-intoxicated patient: a case report

Abstract

Most commonly, patients who present to the emergency department with a history and physical examination suggestive of urinary bladder rupture report a preceding traumatic event. Spontaneous atraumatic bladder rupture is relatively uncommon, but can occur in the context of a recent alcohol binge. The alcohol-intoxicated patient presents diagnostic and therapeutic challenges to the emergency physician (EP) that take on additional urgency given the high mortality of unrecognized bladder rupture. This case report reviews bladder anatomy, the unique physiological changes in the alcohol-intoxicated patient, and the high mortality rate of a ruptured urinary bladder. We review the historical diagnostic imaging options followed by a discussion of how bedside ultrasound could expedite diagnosis and management. We present the case of a patient with spontaneous atraumatic rupture of the urinary bladder after a recent alcohol binge. Bedside ultrasound was utilized by the EP to determine the need for emergent surgical consultation and intervention. We recommend that EPs consider bladder rupture in their initial evaluation of patients presenting with nonspecific abdominal pain in the context of recent alcohol intoxication. When using bedside ultrasound to evaluate the pelvis, the presence of anterior or posterior vesicular fluid collections, the loss of normal pelvic landmarks, or irregularities in the bladder wall may increase the EPs suspicion for this disease entity and expedite time-sensitive management.

Figure 1

Right upper quadrant Morison's pouch view demonstrates free fluid between the liver and the right kidney.

Figure 2

Left upper quadrant view reveals fluid surrounding the inferior pole of the left kidney. Echogenic material is seen floating in the fluid at the lower pole of the kidney.

Figure 3

Pelvic sagittal view. A Foley balloon is seen as well as a heterogenous echogenic collection posterior to it. The walls of the bladder cannot be clearly delineated.

Figure 4

CT of the abdomen showing extensive free fluid.

Figure 5

A large high-density collection in the inferior abdomen compatible with a hematoma.

Figure 6

Collapsed urinary bladder. The urinary bladder is relatively collapsed around a Foley catheter with high-density fluid within the bladder compatible with blood products.