Spontaneous rupture of the urinary bladder with acute hepatic and renal failure: a case report

TL;DR

A rare case of spontaneous bladder rupture leading to liver and kidney failure is reported, emphasizing the need for early diagnosis and surgery to prevent severe complications.

Contribution

This case report highlights the rare presentation of SRUB with acute hepatic and renal failure and underscores the importance of CT cystography and surgical repair.

Findings

CT cystography confirmed spontaneous bladder rupture with contrast extravasation.

Urgent surgical repair and postoperative care led to full recovery.

Early diagnosis and multidisciplinary management are critical to reducing morbidity.

Abstract

Spontaneous rupture of the urinary bladder (SRUB) is a rare but life-threatening emergency that often presents with nonspecific symptoms, leading to delayed diagnosis and severe complications such as peritonitis, sepsis, and multi-organ failure. In rare cases, SRUB may present with multiorgan dysfunction including acute liver and kidney failure, complicating management and recovery. It is commonly associated with underlying bladder dysfunction, including chronic urinary retention and bladder outlet obstruction.

We report a 58-year-old male with a history of benign prostatic hyperplasia (BPH) who presented with acute abdominal pain, fever, jaundice, and hemodynamic instability. Laboratory tests revealed leukocytosis, renal impairment, metabolic acidosis, and hyperkalemia, as well as elevated bilirubin and liver enzyme levels. Abdominopelvic CT with cystography confirmed SRUB, showing contrast extravasation. The patient underwent an urgent exploratory laparotomy, which revealed two bladder tears that were successfully repaired. Postoperative care included broad-spectrum antibiotics, hemodialysis, and intensive monitoring, leading to a full recovery.

SRUB is often misdiagnosed due to its resemblance to gastrointestinal and renal pathologies. This case highlights the importance of a high index of suspicion in patients with risk factors such as bladder outlet obstruction. CT cystography is crucial for early diagnosis, while surgical repair remains the gold standard for treatment. Supportive care, including hemodialysis and infection control, is vital for optimizing outcomes.

Early recognition and prompt surgical intervention are critical in managing SRUB. Clinicians should consider this rare condition in patients with acute abdomen and known bladder dysfunction to reduce morbidity and improve prognosis.

•Spontaneous bladder rupture (SRUB) is a rare but life-threatening urological emergency.•Delayed diagnosis increases the risk of peritonitis, sepsis, and multi-organ failure.•CT cystography is the gold standard for detecting bladder rupture and contrast leakage.•Early surgical intervention with bladder repair ensures optimal recovery and outcomes.•Prompt diagnosis and multidisciplinary management significantly reduce morbidity.

Spontaneous bladder rupture (SRUB) is a rare but life-threatening urological emergency.

Delayed diagnosis increases the risk of peritonitis, sepsis, and multi-organ failure.

CT cystography is the gold standard for detecting bladder rupture and contrast leakage.

Early surgical intervention with bladder repair ensures optimal recovery and outcomes.

Prompt diagnosis and multidisciplinary management significantly reduce morbidity.

Figures