Around 60% to 80% of all bladder injuries result from blunt abdominal trauma, however isolated intraperitoneal urinary bladder rupture is a rare entity (1, 2). The injury has an insidious presentation and often results in delayed diagnosis and management, hence may substantially increases mortality (3,4). We present a case of middle aged male with a delayed presentation of traumatic intraperitoneal bladder rupture that was discovered more than a week after the inciting event. He initially presented to emergency department with acute urinary retention and abdominal distention 5 days after an alleged assaulted. Contrasted CT abdomen demonstrated extravasation of contrast from the dome of the bladder indicating bladder perforation. Emergency laparotomy revealed a 10cm linear tear seen at the bladder dome. Although rare, delayed bladder injury presentation is possible and there should be a high clinical suspicion of bladder injury in trauma patient with unexplained abdominal findings. This case should serve as a cautionary tale for the assessment of the pseudo-renal failure patient. In most patient with urinary ascites, there may be great disturbances in serum biochemistry mimicking renal failure such as elevated urea, creatinine as well as hyperkalaemia.
Traumatic bladder rupture, pseudo-renal failure, ascites
2. Gomez RG, Ceballos L et al. Concensus statement on bladder injuries. BJU International. 2004; 94 (1):27-32.
3. Tezval H, Tezval M et al. Urinary tract injuries in patients with multiple trauma. World Journal of Urology. 2007; 25 (2):177-184.
4. Hsieh CH, Chen RJ, Fang FJ et al. Diagnosis and management of bladder injury of trauma surgeons. American Journal of Surgery. 2002; 184 (2); 143-147.