Spontaneous Intraperitoneal Rupture of Bladder Diverticulum: A Rare Cause of Peritonitis

Abstract

Spontaneous rupture of acquired bladder diverticulum in an adult patient is an extremely rare pathological entity with only 15 cases reported in the available literature. Etiologies are dominated by bladder outlet obstruction, represented mainly by benign prostatic hypertrophy (BPH) in elderly men. Clinical presentation is nonspecific, leading to delayed diagnosis and treatment. Surgical management is the standard approach for intraperitoneal rupture of bladder diverticulum. The prognosis depends on the earliness of treatment, associated comorbidity, and the nature of underlying diseases. Herein, we report a rare case of a 65-year-old male patient, who presented a spontaneous rupture of a large acquired bladder diverticulum, secondary to acute urinary retention complicating benign prostatic hypertrophy. The diagnosis was suspected in the presence of generalized peritonitis associated with lower urinary tract symptoms (LUTS) and was confirmed accurately and promptly by a computed tomography (CT) of the abdomen and pelvis. The patient underwent a successful surgical excision of the diverticulum and bladder repair without delay. The postoperative course was uneventful, and he was discharged from the hospital without any complication.

Spontaneous rupture of bladder diverticulum: a case report of non-traumatic extraperitoneal urinary bladder rupture managed with surgical intervention

“…It commonly occured in the bladder dome which was the weakest point of the bladder wall, causing an intraperitoneal bladder rupture. 6,7 Interestingly, in our case, the perforation site was located at the lateral wall and caused extraperitoneal bladder rupture. Common predisposing factors for spontaneous bladder rupture were associated with either increased intravesical pressure or decreased strength of the bladder wall or its combination.…”

Spontaneous rupture of a bladder diverticulum with delayed open surgical repair

“… 1 Previously reported cases have occurred in the setting of acutely worsening bladder inflammation and/or increased intra-abdominal pressure. 1 , 2 , 3 These cases presented with acute-onset abdominal pain, post-void abdominal pain, distension, urinary ascites, or biochemical evidence of pseudo-acute renal failure due to auto-dialysis of urine. 1 , 2 , 3 Definitive diagnosis of spontaneous rupture has mostly been reported with CT cystogram visualizing the diverticula and the perforation although a role for ultrasound has been reported if CT cystogram is non-diagnostic.…”

“… 1 , 2 , 3 These cases presented with acute-onset abdominal pain, post-void abdominal pain, distension, urinary ascites, or biochemical evidence of pseudo-acute renal failure due to auto-dialysis of urine. 1 , 2 , 3 Definitive diagnosis of spontaneous rupture has mostly been reported with CT cystogram visualizing the diverticula and the perforation although a role for ultrasound has been reported if CT cystogram is non-diagnostic. 2 , 4 , 5 Most cases of extraperitoneal bladder diverticulum rupture have been treated with urinary catheterization and intravenous antibiotics.…”

“… 1 , 2 , 3 Definitive diagnosis of spontaneous rupture has mostly been reported with CT cystogram visualizing the diverticula and the perforation although a role for ultrasound has been reported if CT cystogram is non-diagnostic. 2 , 4 , 5 Most cases of extraperitoneal bladder diverticulum rupture have been treated with urinary catheterization and intravenous antibiotics. 5 Immediate surgical repair, either open or laparoscopic, is most common for intra-peritoneal ruptures, although non-operative management has been performed successfully.…”

“…Spontaneous rupture of a bladder diverticulum is a rare entity with reports of prior cases associated with congenital tissue weakness or acquired weakness due iatrogenic injury, chronic inflammation, or chronic bladder outlet obstruction exacerbated by increased intra-abdominal pressure or acutely worsened inflammation. 1 , 2 In this case, an adult patient presented with spontaneous bladder diverticulum rupture without clear etiology, successfully treated with delayed surgical repair.…”