Spontaneous Rupture Of Urinary Bladder (SRUB); a case series

INTRODUCTION
Spontaneous rupture of urinary bladder (SRUB) is a life threatening event. It is rare and has mortality rate approaching 50%. We would like to report 3 atypical cases of SRUB.

CASE SERIES

Mr A is a 78 years old gentleman, active smoker presented with abdominal pain, distension and hematuria. CT shows bladder dome perforation. Emergency bladder repair without suprapubic cystostomy (spc) was done but complicated with bladder leak post-op. Relaparotomy and repair done but patient succumbed due to septic shock. Hpe of bladder wall edges reported transitional cell carcinoma.

Mr M is a 65 years old gentleman, underlying stroke with neurogenic bladder on cbd presented with acute urinary retention (AUR) with hematuria and clots. Bladder irrigation failed. CT shows bladder perforation. He underwent laparotomy and bladder repair. Post-operatively patient succumbed due to sepsis. Hpe of bladder wall edges revealed fungal infection.

MR L is a 50 years old guy presented with hemiparesis secondary to haemorhagic stroke. In ward, he developed AUR secondary to neurogenic bladder. Due to persistent block after bladder catheterization, ultrasound noted free fluid in pelvis and suspected as perforated bladder. Emergency bladder repair done. Post-op uneventful.

LEARNING POINTS

High index of suspicion needed in these type of cases. CT cystogram is the gold standard for the diagnosis of bladder rupture.  Intraperitoneal bladder injury should always be managed with surgical repair. A bladder biopsy, to exclude other pathology, is recommended.

CONCLUSIONS
Prompt diagnosis of SRUB followed by surgical intervention is the key for successful outcome.