Abstract
We should consider the complication of bladder rupture for patients with worsened abdominal pain and inability to pass urine following acute cystitis. A CT scan is a useful first‐line modality when evaluating for a suspected bladder rupture.
Keywords: acute cystitis, bladder diverticulum, bladder rupture, CT scan, retrograde cystography
We should consider the complication of bladder rupture for patients with worsened abdominal pain and inability to pass urine following acute cystitis. A CT scan is a useful first‐line modality when evaluating for a suspected bladder rupture.
1. INTRODUCTION
A 50‐year‐old woman, taking prednisolone for 20 years to her autoimmune hepatitis, presented with suprapubic pain during urination. She was diagnosed with acute cystitis based on pyuria and bacteriuria. Her initial CT scan showed a bladder diverticulum (Figure 1A). The next day, she was admitted to our hospital because of worsened symptom despite antibiotic therapy. Physical examination revealed suprapubic tenderness with guarding. Laboratory findings showed elevated inflammation markers and serum creatinine level. Repeated CT scan showed the fluid collection in the anteroventral portion of the bladder with thickening of pelvic peritoneum (Figure 1B). Her retrograde cystography revealed contrast material moving outside the bladder into extraperitoneal space (Figure 1C). The perforation site of the diverticulum was not evident by cystoscopy. She was diagnosed with extraperitoneal bladder rupture, which led to pelvic peritonitis and pseudo‐renal failure due to creatinine reabsorption across the peritoneal membrane. The insertion of a urethral catheter improved her symptom dramatically. In addition, urapidil was initiated to the neurogenic bladder as a suspected cause of bladder outlet obstruction and diverticulum.
FIGURE 1.
A, Initial CT scan showed bladder diverticulum (arrow) and thickened bladder wall with stranding in the surrounding fat. B, Repeated CT scan showed fluid collection in anteroventral portion of the bladder (asterisk) with thickening of pelvic peritoneum (arrows). C, Retrograde cystography showed contrast material moving outside the bladder (arrows)
Pathological bladder‐wall fragility and increased intrabladder pressure are recognized as risk factors for nontraumatic bladder rupture. In our case, sequential CT images suggested that distended bladder caused by acute cystitis provoked bladder rupture on the background of bladder‐wall fragility due to long‐term steroid use 1 and/or diverticulum. 2
CONFLICT OF INTEREST
None declared.
AUTHOR CONTRIBUTIONS
MO: drafted the manuscript. TO, KO, and KS: supervised the manuscript. All authors read and approved the final manuscript.
ACKNOWLEDGMENTS
Published with written consent of the patient.
Okano M, Oshita T, Otsui K, Sakaguchi K. Nontraumatic bladder rupture: The images before and after. Clin Case Rep. 2021;9:e04312. 10.1002/ccr3.4312
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
REFERENCES
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.