# Suspected Urine-Induced Chemical Peritonitis Secondary to Invasive Bladder Cancer: A Case Report

## TL;DR

A rare case of chemical peritonitis caused by urine leakage from invasive bladder cancer is reported, highlighting diagnostic and treatment challenges.

## Contribution

This case report adds to the understanding of urine-induced chemical peritonitis in advanced bladder cancer.

## Key findings

- The patient had high-grade urothelial carcinoma with muscle invasion and necrosis.
- Emergency surgery revealed peritoneal inflammation without bladder perforation.
- Early source control is critical in managing this rare complication.

## Abstract

Chemical (urine-induced) peritonitis is a rare but potentially life-threatening complication in patients with advanced bladder cancer. It may result from sterile urinary leakage into the peritoneal cavity, typically through microscopic wall disruption or tumor necrosis. This condition can mimic perforation or bacterial peritonitis, posing a significant diagnostic challenge. We describe the case of a 78-year-old male with de novo high-grade urothelial carcinoma, presenting with persistent gross hematuria, bilateral hydronephrosis, and severe anemia. Despite initial tumor resection and nephrostomy placement, the patient’s condition deteriorated with signs of peritoneal irritation and systemic inflammation. Emergency cystoprostatectomy revealed extensive tumor necrosis and inflammatory peritoneal fluid, but no macroscopic bladder perforation. Histopathology confirmed muscle-invasive high-grade urothelial carcinoma (pT2b) with necrosis and angioinvasion. This report illustrates a diagnostic and therapeutic challenge in the management of advanced bladder cancer complicated by suspected sterile chemical peritonitis, emphasizing the importance of early source control in critically ill patients.