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Case Reports
. 2025 Feb 20;17(2):e79369.
doi: 10.7759/cureus.79369. eCollection 2025 Feb.

Ascites Secondary to Spontaneous Bladder Rupture: A Case Report

Isabel Bessa  1 , Ana Costa  2 , Elisabete Ribeiro  1 , Letícia Marques Leite  1
Affiliations
Case Reports

Ascites Secondary to Spontaneous Bladder Rupture: A Case Report

Isabel Bessa et al. Cureus. .

Abstract

Ascites is a common finding in clinical practice, typically originating from hepatic, malignant, cardiac, renal, or infectious diseases. However, other less frequent etiologies must be considered, making the medical history a critical component in establishing the diagnosis. Acute kidney injury is also frequently seen in the emergency department, arising from diverse causes, some of which may overlap with those of ascites. Late-onset bladder rupture is a rare but serious complication following pelvic radiation therapy. Delayed presentation can lead to diagnostic challenges and life-threatening consequences if unrecognized. We present the case of a 51-year-old female, with a history of cervical cancer treated with chemoradiotherapy 15 years earlier, who presented with progressive abdominal pain, distension, dysuria, and oliguria. Examination revealed a distended abdomen with a palpable fluid thrill. Laboratory findings showed acute kidney injury, leukocytosis, and metabolic acidosis. Initial imaging identified ascites and an empty bladder. After urinary catheterization drained over three liters in one hour, suspicion of bladder rupture arose. A contrast-enhanced CT cystogram confirmed the diagnosis. The patient underwent laparotomy for bladder repair. This case highlights the diagnostic challenge of spontaneous bladder rupture and the importance of considering this diagnosis in patients with a remote history of pelvic radiation. A high index of suspicion is essential in cases of unexplained ascites, acute kidney injury, and urinary abnormalities. Early recognition and surgical intervention are crucial for favorable outcomes.

Keywords: acute kidney injury; ascites; bladder rupture; emergency department; urology.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. CT scan findings on admission
Abdominal CT showing moderate-to-large-volume ascites (marked by the white arrows). Sub-image A displays the coronal plane. Sub-images B and C depict the axial plane.
Figure 2
Figure 2. Follow-up CT scan after catheterization
Abdominal CT after catheterization, showing a reduction in the ascitic fluid (marked by the white arrow). Sub-image A shows the coronal plane. Sub-images B and C show the axial plane.
Figure 3
Figure 3. Follow-up CT scan after the administration of contrast fluid through the urinary catheter
Abdominal CT showing intraperitoneal extravasation of contrast fluid (marked by the green arrows). Sub-image A shows the coronal plane, while sub-image B shows the sagittal plane.
See this image and copyright information in PMC

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