CT findings of spontaneous intraperitoneal rupture of the urinary bladder: two case reports

Abstract

We report two cases of spontaneous bladder rupture. Preoperative diagnosis was difficult and the correct diagnosis was made at surgery. Reviewing the initial abdominopelvic CT of our second patient, the bladder wall defect and blood attenuation near the bladder were observed. These findings were consistent with the operative findings, and would have led to correct preoperative diagnosis if we had had sufficient knowledge of spontaneous bladder rupture. Under urinary catheterization, ascites and free intraperitoneal air were identified in both patients. These findings were indistinguishable from those for bowel perforation, which was our preoperative diagnosis. Significant changes in ascites volume between pre and post urinary catheterization can be an indication of spontaneous bladder rupture.

Acute Abdominal Pain Accompanied by High Creatinine in a Female Patient With Schizophrenia

“…The reported cases of SBR without pre-existing damage have occurred almost exclusively in association with alcohol intoxication alone or in combination with substance abuse. 3,4 Although it has been thought that woman, because of the shorter length of the urethra and the less distinct sphincter mechanism, would exhibit a tendency to leak rather than rupture, several cases of spontaneous bladder perforation in women after binge drinking have been reported. 5 In terms of pathophysiology, the combination of overdistention from increased urine volume and decreased perception of the need to void causing ischemia and possible vesical (micro) infarction has been suggested.…”

“…8 Benzodiazepines, such as lorazepam and diazepam, can provoke urinary retention likely because of muscle relaxation. 6 13 Indwelling urethral and suprapubic catheter 4 Eosinophilic cystitis 14 Pelvic organ prolapse Alcohol intoxication 3,4 and in combination with substance abuse Opioid 15 and benzodiazepine overdose 16 Cases of traumatic or iatrogenic rupture were not included in this overview.…”

“…Delayed diagnosis and treatment can therefore lead to a severe course that is associated with lethal complications. 4,10 Prompt diagnosis followed by intervention is the key to achieving a successful outcome. However, it is often difficult to clinically diagnose bladder ruptures, even with the aid of CT. 4 Indeed, in the present case, the first CT did not lead to the correct diagnosis, although favorable initial therapeutic steps were taken.…”

Spontaneous, idiopathic urinary bladder perforation – case report

“…Imaging examinations, such as abdominal ultrasonography show peritoneal cavity fluid presence in both cases. Abdominal X-ray examinations also raise suspicion of gastrointestinal perforation (2). The presence of peritoneal cavity air during the course of gastrointestinal perforation appears after urinary bladder catheterization.…”

“…The biochemistry of the peritoneal cavity fluid in patients with urinary bladder perforation shows increased values of urea and creatinine (2). Simultaneously, one may observe increased blood values of urea, creatinine, and potassium (6,7).…”