Spontaneous Rupture of Urinary Bladder in a Young Alcoholic Male

Abstract

Spontaneous rupture of the urinary bladder (SRUB) is a rare clinical condition. Prompt diagnosis is often difficult both clinically and radiologically and necessitates a high index of suspicion as the patients present with non-specific abdominal pain and may not offer a clear history. We report this young male who presented with SRUB which occurred after alcohol intoxication and presented to us with vague abdominal pain, anuria, and intraperitoneal fluid collection. He had presented with a painful urinary retention few days prior to this visit, was catheterized temporarily and was discharged on antibiotics with a diagnosis of prostatitis. Currently, he stated that he had not urinated since the recent discharge, and noticed increasing abdominal distension. He also had diffuse severe abdominal pain. Patient stated that prior to this, he had consumed 12 beers. Examination revealed a male in acute distress, with normal ranges vital signs. Abdomen was soft, diffusely tender, with sluggish bowel-sounds, and no rebound-tenderness. Rest of examination was normal. Blood workup was significant for elevated BUN and creatinine from his baseline, and leukocytosis. A Foley catheter was placed. His abdomen computed tomography (CT) scan showed a newly developed pneumoperitoneum. CT cysto-urethrogram confirmed intraperitoneal bladder rupture. The patient had an exploratory laparotomy. The bladder defect was closed, and an indwelling catheter was left to ease healing. He had an uneventful postoperative course, and was discharged with a follow-up appointment in the urology clinic. Spontaneous urinary-bladder rupture is a rare event. Excessive alcohol consumption causes diuresis, over-distension and rupture of the urinary bladder. Initial presentation remains imprecise; continuous urinary leakage leads to abscesses, sepsis, and metabolic derangements. CT scan is imaging modality of choice. The condition is a surgical emergency, and necessitates laparotomy and closure of the breach.




J Med Cases. 2016;7(6):245-247
doi: http://dx.doi.org/10.14740/jmc2470w