A Case of Bladder Rupture Due to Suspected That Presented with Peritonitis

Abstract

A 48–year–old woman presented with a 2–day history of slight fever and was prescribed NSAIDs by another physician. She was transferred to our hospital and was admitted for hypoxemia and hypotension with pyuria and abdominal distention. Laboratory tests revealed elevated inflammatory markers and evidence of renal function impairment. Abdominal computed tomography showed ascites and dilated intestinal segments with thickening of the intestinal wall. There was no free air. We suspected septic shock due to peritonitis of unknown cause and performed emergency laparotomy. Intraoperatively, the bladder wall was found to be irregular and thickened, without any obvious perforation. Based mainly on these clinical findings, we made the diagnosis of bladder rupture of unknown origin with pseudo renal failure. First, the blood urea nitrogen and serum creatinine levels in the ascites fluid were much higher than the corresponding levels in the blood. Second, her renal function improved significantly on the day after the surgery. Finally, bacterial culture of both blood and ascites fluid were positive for E. coli. After treatment, the patient was discharged on day 33. Thus, in cases with suspected bladder rupture, examination of the ascites fluid may be useful.