Abstract
A 78-year-old man visited his previous physician with a chief complaint of sudden right lower quadrant abdominal pain. He was referred with suspected gastrointestinal perforation. Abdominal contrast-enhanced computed tomography (CT) showed intraperitoneal free air and ascites, as well as fluid accumulation accompanied by air adjacent to the anterior bladder wall. Since gastrointestinal perforation could not be ruled out, exploratory laparotomy was performed on the same day. No gastrointestinal abnormalities were found intraoperatively. Retrograde cystography was performed on postoperative day 3, and the patient was diagnosed as having an urinary bladder perforation. Since urinary drainage was effective after urinary catheterization, conservative treatment was given, and the patient's condition improved. Spontaneous urinary bladder rupture is rare, and because it presents with various clinical symptoms, it is difficult to accurately diagnose preoperatively, and differential diagnosis from other causes of acute abdomen is an issue. The present case and a review of the literature suggest that bladder rupture should be suspected in patients with extraperitoneal findings such as fluid accumulation and air around the bladder.
