Non‐traumatic bladder rupture showing less than 10 Hounsfield units of ascites

Abstract

Aim: Bladder ruptures are commonly misdiagnosed as gastrointestinal perforations or intestinal ischemia. If a diagnosis is made preoperatively, conservative treatment is a safe and effective option. We evaluated the validity of using the attenuation value of ascites, measured by non-contrast computed tomography (CT), to identify patients with bladder ruptures.Methods: A retrospective search of our hospital database identified 7 patients with confirmed bladder ruptures between 2007 and 2013. We also enrolled 18 patients with gastrointestinal perforations and 10 patients with intestinal ischemia with detectable ascites on abdominal CT that had undergone emergency exploratory laparotomy between 2007 and 2013. Between-group comparisons of attenuation values of ascites as obtained by non-contrast CT were evaluated.Results: All attenuation values were less than 10 Hounsfield units (HU) in bladder rupture patients. Moreover, the attenuation value of ascites in cases of bladder rupture (median, 5.7; range, 3.1-6.1) was significantly lower than in cases of gastrointestinal perforation (median, 14.7; range, 4.7-25.4) and intestinal ischemia (median, 13.3; range, 6.0-18.1) (P = 0.004 for both comparisons). Conclusion:Bladder rupture mimics gastrointestinal perforation and intestinal ischemia with acute kidney injury. Therefore, the diagnosis of bladder rupture using the attenuation value of ascites on non-contrast CT is both useful and highly significant. We suggest that bladder rupture be considered in the differential diagnosis of patients presenting with acute abdominal pain and attenuation values of ascites of less than 10 Hounsfield units.

A case of ureteral obstruction and sepsis induced by bladder perforation following intravesical bacillus Calmette–Guérin successfully treated with an antituberculous agent, antimicrobial chemotherapy and percutaneous urine drainage

“…Notably, our patient had sepsis because of bladder perforation induced by intravesical BCG treatment and the bladder perforation developed into a fluctuant perivesical abscess and bilateral ureteral obstruction. Some reports have revealed the causes of bladder perforation, including TURBT, interstitial cystitis, neurogenic bladder, radiation cystitis, bladder cancer and an indwelling urethral catheter [9][10][11]. Recently, bladder perforation associated with instillation of intravesical mitomycin C (MMC) after TURBT was reported [12,13].…”

The diagnostic challenge of non-traumatic bladder rupture: a pictorial essay

“…In our case series, the patients were often complained of non-specific symptoms; abdominal pain (83%), following fever (37.5 °C or higher), abdominal distension and urinary retention. It is clinically important to differentiate unexpected NTBR from other acute abdomen by CT findings [ 8 ].…”

“…Perforation of the small intestine is more common and represents similar CT findings. Mizumura et al reported that BR should be considered when the ascites showed less than 10 HU [ 8 ]. CT values of ascites were not specific, but a massive low dense ascites reached to the liver surface can be the key to differentiate BR from small bowel perforation.…”