Repeat spontaneous bladder rupture following radiation therapy

Spontaneous Rupture of Urinary Bladder: Two Case Reports and Review of Literature

Objectives: Spontaneous rupture of the urinary bladder (SRUB) is extremely rare and might be misdiagnosed, leading to a high mortality rate. The current study aimed to identify the cause, clinical features, and diagnosis strategy of SRUB. Methodology: We presented a case report for two women (79 and 63 years old) misdiagnosed with acute abdomen and acute kidney injury, respectively, who were finally confirmed to have SRUB by a series of investigations and exploratory surgery. Meanwhile, literature from multiple databases was reviewed. PubMed, the Chinese National Knowledge Infrastructure (CNKI), the Chinese Biological Medical Literature Database (CBM), WANFANG DATA, and the Chongqing VIP database for Chinese Technical Periodicals (VIP) were searched with the keywords "spontaneous bladder rupture" or "spontaneous rupture of bladder" or "spontaneous rupture of urinary bladder." All statistical analyses were conducted using SPSS 20.0 software. Results: A total of 137 Chinese and 182 English literature papers were included in this article review. A total of 713 SRUB patients were analyzed, including the two patients reported by us. The most common cause of SRUB was alcohol intoxication, lower urinary tract obstruction, bladder tumor or inflammation, pregnancy-related causes, bladder dysfunction, pelvic radiotherapy, and history of bladder surgery or bladder diverticulum. Most cases were diagnosed by exploratory laparotomy and CT cystography. Patients with extraperitoneal rupture could present with abdominal pain, abdominal distention, dysuria, oliguria or anuria, and fever. While the main symptoms of intraperitoneal rupture patients could be various and non-specific. The common misdiagnoses include acute abdomen, inflammatory digestive disease, bladder tumor or inflammation, and renal failure. Most of the patients (84.57%) were treated by open surgical repair, and most of them were intraperitoneal rupture patients. Overall, 1.12% of patients were treated by laparoscopic surgery, and all of them were intraperitoneal rupture patients. Besides, 17 intraperitoneal rupture patients and 6 extraperitoneal rupture patients were treated by indwelling catheterization and antibiotic therapy. Nine patients died of delayed diagnosis and treatment. Conclusions: SRUB often presents with various and non-specific symptoms, which results in misdiagnosis or delayed treatment. Medical staff noticing abdominal pain suggestive of peritonitis with urinary symptoms should be suspicious of bladder rupture, especially in patients with a history of bladder disease. CT cystography can be the best preoperative non-invasive examination tool for both diagnosis and evaluation. Conservative management in the form of urine drainage and antibiotic therapy can be used in patients without severe infection, bleeding, or major injury. Otherwise, surgical treatment is recommended. Early diagnosis and management of SRUB are crucial for an uneventful recovery.

Case: Spontaneous bladder rupture presenting as sudden-onset abdominal pain in a child after many years in remission from bladder rhabdomyosarcoma

Bladder rupture in the absence of trauma (spontaneous bladder rupture) is a rare but life-threatening phenomenon, commonly associated with pelvic malignancy1,2 and postvaginal delivery.3 In children, case reports of spontaneous bladder rupture are most often idiopathic or associated with congenital genitourinary malformations (e.g., posterior urethral valve) and bladder augmentation surgery.4 Since bladder rupture often presents with acute abdominal pain, the diagnosis can be missed, leading to delayed treatment and poor outcomes. Here, we describe the second case in the literature, to our knowledge, of spontaneous bladder rupture in a pediatric patient with prior bladder rhabdomyosarcoma.

Conservatively managed spontaneous intraperitoneal bladder perforation in a patient with chronic bladder outflow obstruction

We present the unusual case of a spontaneous intraperitoneal bladder rupture as a first presentation of chronic bladder outflow obstruction secondary to benign prostatic hyperplasia. A contributing factor to diagnostic delay was unfamiliarity with the classical presentation of abdominal pain, abdominal distension and urinary ascites leading to autodialysis represented by an unusually high serum creatinine. A cystogram was performed after a non-contrast computed tomography (CT) scan originally performed to determine the cause of abdominal pain, failed to confirm the diagnosis. The patient's initial acute presentation was successfully managed conservatively with prolonged urinary catheterization.

Micropapillary carcinoma of the bladder presented with spontaneous intraperitoneal bladder rupture

Spontaneous bladder perforation is a rare presenting feature of bladder malignancy. We describe an unusual case of a patient, admitted to emergency, with diffuse abdominal pain due to spontaneous bladder rupture in association with a micropapillary carcinoma. A diagnosis of an intraperitoneal bladder perforation was made during an emergency operation. Aspects of etiology, clinical presentation, diagnosis and management are described. Although cases of spontaneous carcinomatous bladder rupture are associated with high morbidity and mortality, prompt identification and treatment can lead to favourable outcomes.

Spontaneous bladder rupture in non-augmented bladder exstrophy

Childhood spontaneous bladder rupture is an uncommon event, usually associated with bladder augmentation. Occasionally it occurs in normal bladders or non-augmented bladders with a predisposing factor. We present a unique case of misdiagnosed spontaneous bladder rupture in a non-augmented bladder exstrophy patient without evidence of lower urinary outlet obstruction. His acute abdomen mimicked appendicitis and was managed with laparoscopic exploration, intraperitoneal fluid drainage, appendectomy and bladder drainage. This case highlights the need for pediatric urological consultation by surgeons in the case of an acute abdomen with free fluid in a patient with an abnormal bladder.

[Spontaneous extraperitoneal bladder perforation in an elderly patient with genitalia prolapse]

There are many etiologic reasons which explain the bladder perforation. Bladder injuries happen most commonly in poli-traumatisms (traffic accident), blunt trauma, penetrating injury and iatrogenic injury (surgery, laparoscopic...). However, there is not always a vigorous, direct, extern and blunt agent causing the rupture. In the case reported the extraperitoneal bladder rupture started after a smooth perineal injury caused when the patient seated down. The patient already suffered from a cystocele III/IV plus uterine prolapse for a long time ago.