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Zhang Z, Shen J, He Q, Nie H. Spontaneous rupture of bladder diverticulum with pseudo renal failure:A case report and literature review. Am J Emerg Med 2024; 79:231.e3-231.e7. [PMID: 38508995 DOI: 10.1016/j.ajem.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Spontaneous or non-traumatic bladder rupture is rare but can be life-threatening. Bladder rupture caused by a diverticulum is extremely rare, with only a few case reports in medical literature. CASE PRESENTATION We report the case of a 32-year-old woman admitted to hospital complaints of abdominal pain, oliguria and ascites with no history of trauma. Laboratory tests revealed an elevated serum urea nitrogen(UN) level of 33.5 mmol/l and an elevated creatinine levels of 528 umol/l. X-ray cystography confirmed the rupture of a bladder diverticulum. Subsequent transurethral catheterization led to a prompt increase in urinary output, and serum creatinine level returned to 40 umol/l within 48 h. The patient was successfully treated with laparoscopic diverticulectomy. CONCLUSION Clinicians should maintain a high level of suspicion for urinary bladder rupture in cases presenting with acute lower abdominal pain, urinary difficulties, and oliguria. When acute renal failure, complicated ascites, and an elevated peritoneal fluid creatinine or potassium level exceeding serum levels are observed, intraperitoneal urine leakage should be suspected without delay. This case emphasizes the importance of early diagnosis and intervention in managing this rare but serious condition.
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Affiliation(s)
- Zhuo Zhang
- Department of Emergency Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jing Shen
- Department of Emergency Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qian He
- Department of Emergency Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Hu Nie
- Department of Emergency Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Xiamen Hospital of Sichuan University, Xiamen, Fujian, China.
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2
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Sharma A, Biswal D, Sharma S, Roy S. An elderly male with lower urinary tract symptoms during COVID-19 pandemic: Extraperitoneal perforation of bladder diverticulum. Urologia 2023; 90:763-765. [PMID: 34082626 DOI: 10.1177/03915603211022945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CASE We present a case of spontaneous extra-peritoneal rupture of an acquired diverticulum an elderly male with symptoms of bladder outlet obstruction who presented in emergency with acute abdomen. OUTCOME The acute phase was managed conservatively with bladder drainage and intravenous antibiotics. He recently underwent Transurethral Resection of Prostate. He is asymptomatic on follow-up. CONCLUSIONS Acquired bladder diverticulum are rare in adults and are mostly seen in patients with high pressure bladder due to bladder outlet obstruction. Atraumatic extraperitoneal ruptures of diverticulum are uncommonly reported.
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Affiliation(s)
- Amit Sharma
- Department of Urology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Deepak Biswal
- Department of Urology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Satyadeo Sharma
- Department of Urology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Siddhant Roy
- Department of Urology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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3
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Huang J, Tai S, Ding H, Xu L, Hua R, Yu Y, Mao D. A Rare Case of Spontaneous Bladder Rupture in a Herpes Zoster Patient. Infect Drug Resist 2022; 15:5193-5196. [PMID: 36090602 PMCID: PMC9462514 DOI: 10.2147/idr.s380752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/01/2022] [Indexed: 11/26/2022] Open
Abstract
Herpes zoster infection in the sacral area accounts for a considerable number of all herpes zoster cases, and cases of acute urinary retention and defecation disorders caused by herpes zoster infection in the sacral area have been reported. However, no clinical case of spontaneous bladder rupture has been reported. In this report, we describe a 77-year-old male patient with severe complications of spontaneous bladder rupture caused by herpes zoster-associated urinary retention. The patient regained complete bladder function after undergoing surgery to repair the bladder and treatment with antiviral drugs.
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Affiliation(s)
- Jiaguo Huang
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, People's Republic of China
| | - Shengcheng Tai
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, People's Republic of China
| | - Hongxiang Ding
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, People's Republic of China
| | - Li Xu
- School of Medicine, Hangzhou Normal University, Hangzhou, People's Republic of China
| | - Runmiao Hua
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, People's Republic of China
| | - Yufu Yu
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, People's Republic of China
| | - Dikai Mao
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, People's Republic of China
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4
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Ostrowski DA, Cortese BD, Chelluri RR, Kovell RC, Wein AJ, Lee DJ. Spontaneous rupture of a bladder diverticulum with delayed open surgical repair. Urol Case Rep 2022; 44:102165. [PMID: 35935118 PMCID: PMC9350868 DOI: 10.1016/j.eucr.2022.102165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/16/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
| | | | | | | | | | - Daniel J. Lee
- Corresponding author. Division of Urology, Department of Surgery, University of Pennsylvania, Penn Urology Perelman, 3rd Floor West Pavilion, 3400 Civic Center Boulevard, Philadelphia, PA, USA.
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Eghbali F, Mosavari H, Madankan A, Hariri V, Garakani K, Bhahdoust M. Generalized peritonitis secondary to spontaneous rupture of the urinary bladder in a diabetic patient: A case report. Int J Surg Case Rep 2022; 97:107458. [PMID: 35930990 PMCID: PMC9403300 DOI: 10.1016/j.ijscr.2022.107458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/23/2022] [Accepted: 07/24/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Spontaneous rupture of the urinary bladder (SRUB) secondary to emphysematous cystitis(EC) in diabetic patients is extremely rare. Clinical presentations are often non-specific and display the signs and symptoms of peritonitis. The diagnosis is usually made after exploratory laparotomy. CASE REPORT A 70-year-old diabetic woman presented to the emergency department with sudden diffuse abdominal pain and hematuria of six hours duration. Physical examination revealed generalized peritonitis. Multi-slice abdominal and pelvic CT scans showed free air and fluid in the abdominal cavity. After proper resuscitation, the patient was transferred to the operating room for exploratory laparotomy. A 2 cm full-thickness bladder rupture was noted at the dome of the bladder, which was repaired. CLINICAL DISCUSSION We noticed free air in the urinary bladder wall postoperatively in the CT scan, which is the radiological sign of EC. The Pathology result was in concordance with the diagnosis. CONCLUSIONS SRUB in patients with poorly controlled diabetes and EC is highlighted in this case study. Urinary bladder rupture secondary to EC should be considered When a diabetic patient with a history of urinary symptoms presents with an acute onset of abdominal pain suggestive of peritonitis. Uneventful recovery from SRUB is dependent on early diagnosis and treatment.
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Affiliation(s)
- Foolad Eghbali
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran,Corresponding author at: Minimally Invasive Surgery Research Center, Rasool-e-Akram Hospital, Niyayesh Ave, Sattarkhan St., Tehran, Iran.
| | - Hesam Mosavari
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Madankan
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Hariri
- Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Kiana Garakani
- Student in Molecular Cell Biology and Data Science, University of California Berkeley, San Francisco, CA, USA
| | - Mansour Bhahdoust
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran,Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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6
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Inoguchi K, Hongo T, Naito H, Nakao A. A Rare Case of Pelvic Abscess Due to Spontaneous Non-traumatic Bladder Rupture. Cureus 2021; 13:e18913. [PMID: 34812299 PMCID: PMC8604095 DOI: 10.7759/cureus.18913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/05/2022] Open
Abstract
Spontaneous bladder rupture is an uncommon and life-threatening urological emergency, and early diagnosis is often challenging. Herein, we report a case of intraperitoneal bladder rupture in an 81-year-old male with neurogenic bladder-the case of intraperitoneal bladder rupture required late laparotomy for pelvic abscess following initial conservative treatment. An eighty-one-year-old male presented to our emergency department with deterioration of consciousness, fever, and hematuria. He denied previous trauma history and had been treated for neurogenic bladder. Physical examination revealed signs of tenderness in the abdomen. A diagnosis of bladder rupture was made based on laboratory examination indicating renal failure and radiological imaging showing urinary ascites. Conservative management with a Foley catheter and antibiotics (meropenem administered 1 g/day) was initiated. On day seven after admission, the patient complained of abdominal pain and fever, and a diagnosis of pelvic abscess based on contrast-enhanced computed tomography and septic peritonitis was made. An emergency exploratory laparotomy for peritoneal drainage was performed. The postoperative course was uneventful, and the patient was discharged on day 29 after admission. Urinary bladder rupture should always be considered as a differential diagnosis in patients presenting with free fluid in the abdomen, peritonitis, reduced urine output, and hematuria. Clinicians should be aware that secondary bacterial peritonitis can occur as a major complication of a ruptured urinary bladder.
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Affiliation(s)
- Kyosuke Inoguchi
- Emergency Department, Okayama Saiseikai General Hospital, Okayama, JPN
| | - Takashi Hongo
- Emergency Department, Okayama Saiseikai General Hospital, Okayama, JPN.,Emergency, Critical Care, and Disaster, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
| | - Hiromichi Naito
- Emergency, Critical Care, and Disaster, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
| | - Atsunori Nakao
- Emergency, Critical Care and Disaster, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, JPN
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7
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Cheung D, de Terwangne C, Guillen M, Sorgente A, Ballout A, Jacques J. Pseudo-acute kidney injury after minor trauma: A case report and review of literature. J Am Coll Emerg Physicians Open 2021; 2:e12564. [PMID: 34693398 PMCID: PMC8514145 DOI: 10.1002/emp2.12564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/26/2021] [Accepted: 09/02/2021] [Indexed: 11/08/2022] Open
Abstract
Acute kidney injury (AKI), a common diagnosis in the emergency department, is defined as a reduction in renal filtration function, with decrease in urine output, increase in serum creatinine, or both. However, a rise in serum creatinine can occur without AKI: the principal cause of a pseudo-AKI is urinary ascites, caused by urinary tract rupture, followed by reverse intraperitoneal dialysis and resorption of creatinine. The intraperitoneal leak of free urine is mainly traumatic, and half of the cases are iatrogenic. A case of intraperitoneal bladder rupture after minor trauma is presented with a review of the pathology of pseudo-AKI.
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Affiliation(s)
- Diana Cheung
- Department of Emergency MedicineEpicura Centre HospitalierBrusselsBelgium
| | | | | | - Antonio Sorgente
- Department of CardiologyEpicura Centre HospitalierBrusselsBelgium
| | - Assma Ballout
- Department of Emergency MedicineEpicura Centre HospitalierBrusselsBelgium
| | - Jean‐Marie Jacques
- Department of Emergency MedicineEpicura Centre HospitalierBrusselsBelgium
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A Complex Case of Emphysematous Cystitis in a Peritoneal Dialysis Patient. Case Rep Nephrol 2021; 2021:8343022. [PMID: 34306777 PMCID: PMC8282390 DOI: 10.1155/2021/8343022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/03/2021] [Indexed: 11/17/2022] Open
Abstract
Emphysematous cystitis (EC) is a relatively rare condition characterized by gas formation in the bladder wall and/or lumen. We report a case of emphysematous cystitis with a bladder perforation in an 84-year-old male on peritoneal dialysis who presented with fever, dysuria, hematuria, and hypotension. Gas in the bladder wall, as well as a small perforation in the roof of the urinary bladder, was seen on the abdominal CT scan. The causative organism identified was Escherichia coli. The patient recovered with broad-spectrum antibiotics along with bladder irrigation and drainage. After initial bladder washouts, peritoneal dialysis was continued with close monitoring. Early antibiotic therapy and a conservative approach to the management of small intraperitoneal bladder perforations were effective in this patient. Peritoneal dialysis was uninterrupted for the duration of the admission and after discharge.
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Ibrahimi A, Dergamoun H, Ziani I, Makhoukhi ZEBE, Sayegh HE, Benslimane L, Nouini Y. Successful conservative management of a spontaneous intraperitoneal urinary bladder rupture secondary to benign prostatic hyperplasia: a case report. Pan Afr Med J 2021; 38:268. [PMID: 34122695 PMCID: PMC8179998 DOI: 10.11604/pamj.2021.38.268.26684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/28/2021] [Indexed: 11/23/2022] Open
Abstract
A spontaneous intraperitoneal bladder rupture is a rare, serious and life-threatening surgical emergency of various etiologies, with unspecific clinical presentation, and difficult diagnosis. Surgical treatment is the standard therapy for intraperitoneal bladder rupture; however, there is an increasing tendency toward conservative management in selected patients with favorable characteristics. Herein, we report a rare case of a 65-year-old male patient presented to the emergency department with intraperitoneal bladder rupture following an episode of acute urinary retention due to benign prostatic hyperplasia, and which was successfully managed conservatively with urinary bladder catheterization and antibiotic therapy, without any complication.
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Affiliation(s)
- Ahmed Ibrahimi
- Department of Urology A, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Hamza Dergamoun
- Department of Urology A, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Idriss Ziani
- Department of Urology A, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Zayd El Boukili El Makhoukhi
- Department of Urology A, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Hachem El Sayegh
- Department of Urology A, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Lounis Benslimane
- Department of Urology A, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Yassine Nouini
- Department of Urology A, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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10
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Spontaneous Intraperitoneal Rupture of Bladder Diverticulum: A Rare Cause of Peritonitis. Case Rep Urol 2020; 2020:8880748. [PMID: 33343963 PMCID: PMC7725554 DOI: 10.1155/2020/8880748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/21/2022] Open
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.
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Ibrahimi A, Ziani I, El Boukili El Makhoukhi Z, El Sayegh H, Benslimane L, Nouini Y. Transurethral resection syndrome: A rare complication of intraperitoneal bladder perforation during transurethral resection of bladder tumor. Urol Case Rep 2020; 34:101465. [PMID: 33145173 PMCID: PMC7591725 DOI: 10.1016/j.eucr.2020.101465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 10/20/2020] [Accepted: 10/24/2020] [Indexed: 11/18/2022] Open
Abstract
Transurethral resection (TUR) syndrome is a rare and serious complication of bladder perforation during transurethral resection of bladder tumor (TURBT), secondary to the excessive absorption of electrolytes-free irrigating fluid by extravascular route. Its defined as the combination of clinical cardiovascular and/or neurological manifestations, along with hyponatremia. Herein we report a rare case of 61-year-old patient, who presented a typical and severe TUR syndrome, secondary to intraperitoneal bladder perforation during TURBT, requiring intubation and positive inotropic drugs in the intensive care unit (ICU), and which was successfully managed conservatively. The patient was discharged from the hospital without any complications.
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