Nontraumatic urinary bladder rupture presenting as renal pseudo-failure and ascites

Abstract

A 24-year-old man, with past medical history significant only for nocturnal enuresis until the age of 12 years, presented to the emergency department with acute abdominal pain after an episode of difficulty with micturition in the middle of the night. On presentation, physical examination was suggestive of ascites and laboratories revealed an elevated serum creatinine of 1.88 mg/dL. He was subsequently found to have a ruptured bladder, without any inciting trauma, which required surgical repair. His only surgical history is an unknown, apparently urologic, surgery when he was 11-12 years old. The patient's unique presentation prompts discussion of bladder rupture and its manifestations, the role of clinical information in informing imaging protocol, and the importance of sagittal images in identifying pathology.

Regression of Renal Failure after Unilateral Simple Nephrectomy

“…This leakage may result in perirenal extravasation and eventually urinary ascites. Sometimes this situation presents as renal pseudo-failure (laboratory abnormalities of acute kidney injury in the setting of normal kidney function) [18][19][20]. In our case severe obstruction secondary to kidney stone and high intrarenal pressure may be causing perirenal urine extravasation.…”

Spontaneous (idiopathic) rupture of the urinary bladder: a systematic review of case series and reports

“…Once exclusion criteria were applied to the abstracts, 352 studies remained for full‐text review. After again applying the exclusion criteria to the full texts, a total of 278 manuscripts remained and were included in the final review […”

“…Another confounding issue contributing to the misdiagnosis of SRUB is the peritoneal reabsorption of urea and creatinine that has escaped through the bladder wall defect, leading to elevated serum readings when laboratory investigations are performed. These results may easily be misinterpreted as renal failure [30,31,52,71,75,77,88,94,95,103,156,179,180,233], which is further confounded by presentation with oliguria or anuria [143,168,183], leading to the initiation of renal replacement therapy. When the diagnosis is made reasonably early and the defect repaired or bladder drained to allow sufficient healing to occur, the levels of urea and creatinine generally resolve spontaneously within 24 h [179].…”

Uroperitoneo como causa de ascitis recurrente. Una etiología que no debe ser olvidada

“…La pseudoinsuficiencia renal se define como elevación de la creatinina sérica, que simula una lesión renal aguda, a menudo de etiología no filiada luego de excluir causas tradicionales (28) . El uroperitoneo se caracteriza por incrementos en la creatinina sérica por reabsorción de la creatinina urinaria mediada por la membrana peritoneal, y a su vez, la fuga de orina intraabdominal de manera crónica aumenta la reabsorción anormal de metabolitos tóxicos, razón por la cual se debe pensar en esta entidad ante la presencia de lesión renal aguda junto con ascitis o peritonitis y alteraciones electrolíticas como hiponatremia, hiperpotasemia y acidosis metabólica (10,27,29) .…”