Beware of the 'Ascites' Patient: Delayed Presentation of Traumatic Intraperitoneal Bladder Rupture

Abstract

Delayed diagnosis of an intraperitoneal bladder rupture is rare in the post CT era. We present a case of a middle aged male with a delayed presentation of a traumatic intraperitoneal bladder rupture. He initially presented with an acute distended abdomen and acute kidney injury after an alleged assault. He was initially admitted for investigation of his 'ascites.' This case to our knowledge is the longest delay to diagnosis (>2 weeks) for an intraperitoneal bladder rupture in the post computed tomography era and should serve as a learning point in the workup of the patient with suspected blunt bladder injury.

Keywords: Bladder rupture; Diagnosis; Trauma.

Figure 1

Admission computed tomography of abdomen demonstrating free intraperitoneal fluid (white arrows).

Figure 2

Left bladder dome perforation demonstrated on flexible cystoscopy.

Figure 3

Intraoperative picture of bladder perforation (black arrow).

Figure 4

Cystogram 4 weeks post repair demonstrating no leak.