A Case of Spontaneous Rupture of the Urinary Bladder After Radiation Therapy which was Initially Suspected as a Gastrointestinal Perforation

Abstract

A 77-year-old woman was admitted to our hospital with a history of fever, abdominal pain, and disturbance of consciousness. She had a past medical history of having undergone total hysterectomy followed by radiation therapy 23 years earlier . Physical examination revealed signs of peritoneal irritation and a plain CT of the abdomen showed a large amount of ascites and a small amount of free air. We diagnosed the patient as having panperitonitis caused by gastrointestinal perforation, and performed emergency operation. Intraoperative exploration revealed purulent ascites, but no perforation in the gastrointestinal tract; however, a perforation was found on the top of the urinary bladder. We finally made the diagnosis of spontaneous rupture of the urinary bladder caused by radiation, repaired the defect and covered it with omentum. We discharged the patient from our hospital with an indwelling urinary catheter. This case serves to underscore the importance of bearing in mind the possibility of spontaneous rupture of an abdominal organ in patients with a past medical history of radiation therapy who present with abdominal pain. It is also important to carefully monitor the urinary symptoms in patients who have undergone radiation therapy for the region, for early diagnosis of rupture of urinary bladder.