Nontraumatic urinary bladder rupture presenting as renal pseudo-failure and ascites

Abstract

A 24-year-old man, with past medical history significant only for nocturnal enuresis until the age of 12 years, presented to the emergency department with acute abdominal pain after an episode of difficulty with micturition in the middle of the night. On presentation, physical examination was suggestive of ascites and laboratories revealed an elevated serum creatinine of 1.88 mg/dL. He was subsequently found to have a ruptured bladder, without any inciting trauma, which required surgical repair. His only surgical history is an unknown, apparently urologic, surgery when he was 11-12 years old. The patient's unique presentation prompts discussion of bladder rupture and its manifestations, the role of clinical information in informing imaging protocol, and the importance of sagittal images in identifying pathology.

Keywords: Ascites; Bladder rupture; Renal failure; Urology.

Fig. 1

(A) Transverse slice of CT abdomen without contrast on day 1 showing free fluid collections around the liver and spleen. (B) Sagittal slice CT abdomen without contrast on day 1 notable for disruption of smooth demarcation of bladder wall in the dome of the bladder sagittal reconstruction showing findings consistent with bladder rupture. CT, computed tomography.

Fig. 2

Fluoroscopic cystourethrogram on day 7 after original admission. Findings: Transit of contrast outside the bounds of the bladder and ureters was noted from the right side of the urinary bladder.