Urinary Bladder Perforation: A Forensic Case Report and Brief Literature Review

TL;DR

A 69-year-old woman with a history of bladder cancer died from peritonitis caused by a bladder perforation, highlighting the severity of this rare condition.

Contribution

This case report adds to the limited literature on spontaneous bladder perforation and its fatal complications.

Findings

Bladder perforation can lead to life-threatening peritonitis with a high mortality rate.

Spontaneous bladder rupture may occur in patients with a history of bladder cancer and prior TURBT.

Prompt diagnosis and treatment are critical to prevent fatal outcomes.

Abstract

Urinary bladder ulceration and perforation are serious conditions that may develop due to various causes, most commonly trauma or complications from medical procedures. In rare instances, these conditions can occur without an identifiable cause. Bladder perforation can lead to peritonitis, a life-threatening complication with a reported mortality rate approaching 50%, primarily due to systemic inflammatory responses and multi-organ failure. Although spontaneous bladder rupture is uncommon, it has been associated with underlying conditions such as bladder outlet obstruction (BOO), malignancy, and chronic infections, or it may occur without a clearly identifiable cause (idiopathic). Prompt recognition and intervention are essential to improving patient outcomes.

We present the case of a 69-year-old woman with a medical history of diabetes mellitus, arterial hypertension, and knee osteoarthritis, for which she was receiving insulin, irbesartan, and hydrochlorothiazide. Additionally, approximately three years prior to her death, she was diagnosed with a urinary bladder neoplasm and underwent transurethral resection of the bladder tumor (TURBT), followed by intravesical therapy.

Postmortem examination (PME) revealed evidence of peritonitis. Histopathological examination confirmed the diagnosis of peritonitis, along with bladder ulceration and perforation. The cause of death (COD) was determined to be peritonitis secondary to bladder perforation.

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