SUMMARY Six cases of spontaneous rupture of the bladder are described, and reviewed together with sixty‐six cases collected from the literature in the last twenty‐five years. There were sixty‐six cases of intraperitoneal rupture, five cases of extraperitoneal rupture, and one case of combined intraperitoneal and extraperitoneal rupture. The cases of intraperitoneal rupture are classified into two main groups according to whether there was a lesion of the bladder wall or whether the rupture was secondary to retention. The retention group is divided into three sub‐groups: one with neurological disorders, one with urinary obstruction, and a third miscellaneous group, where the rupture is considered to be secondary to a reflex retention. Rupture usually occurs through the vault of the bladder and is usually small in lesions of the bladder wall. Diagnosis depends on a history of pain and disturbance of micturition, and the signs of peritonitis. Catheterisation and withdrawal of blood‐stained urine confirms the diagnosis, but occasionally the urine is clear. The mortality was 47 per cent, and has not fallen during the last twenty‐five years. Carcinoma, tuberculosis, and enlarged prostate accounted for two‐thirds of the mortality.

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