Bladder perforation caused by long-term catheterization misdiagnosed as digestive tract perforation: A case report

Pneumoperitoneum and peritonitis secondary to perforation of an infected bladder

“…Spontaneous bladder rupture represents only 3.4% of these cases [ 2 ]. It results mostly from an underlying pathology [ 1 , 2 , 10 , 13 ], and is a rare complication of urosepsis [ 1 , 2 , 6 ].…”

“…Diagnosis of bladder perforation is rarely done preoperatively [ 1 , 4 , 6 ], often delayed [ 7 , 14 ] or discovered only during laparotomy [ 1 , 6 ]. Abdominal pain or peritonitis is the usual presentation.…”

“…Forty percent of bladder ruptures are intraperitoneal [ 3 ]. In the majority of cases, the presumed, but mistaken, diagnosis is digestive tract perforation [ 2 , 6 , 10 , 14 ], particularly in the presence of pneumoperitoneum [ 2 , 6 , 10 ]. Computed tomography usually shows free fluid [ 4 , 7 , 14 ], but pneumoperitoneum is demonstrated in 16% of the cases [ 9 ].…”

“…Catheterization or indwelling catheter may also be a risk or contributing factor for bladder rupture [ 1 , [3] , [4] , [5] , [6] , [7] , [8] ]. Among the other associated complications with bladder perforation, the occurrence of pneumoperitoneum is very unusual [ 2 , [4] , [5] , [6] , 9 , 10 ]. In majority of bladder perforation cases, clinical presentation, radiology imaging, and rarity lead to misdiagnosis as digestive tract perforation [ 2 , 6 ].…”

“…Among the other associated complications with bladder perforation, the occurrence of pneumoperitoneum is very unusual [ 2 , [4] , [5] , [6] , 9 , 10 ]. In majority of bladder perforation cases, clinical presentation, radiology imaging, and rarity lead to misdiagnosis as digestive tract perforation [ 2 , 6 ]. We describe a case of unsuspected bladder perforation presenting with peritonitis and free air under the diaphragm.…”