Micropapillary carcinoma of the bladder presented with spontaneous intraperitoneal bladder rupture

Spontaneous bladder perforation is a rare presenting feature of bladder malignancy. We describe an unusual case of a patient, admitted to emergency, with diffuse abdominal pain due to spontaneous bladder rupture in association with a micropapillary carcinoma. A diagnosis of an intraperitoneal bladder perforation was made during an emergency operation. Aspects of etiology, clinical presentation, diagnosis and management are described. Although cases of spontaneous carcinomatous bladder rupture are associated with high morbidity and mortality, prompt identification and treatment can lead to favourable outcomes.     

A Case Series of Spontaneous Rupture of the Urinary Bladder

We report 2 cases of spontaneous bladder rupture related to chronic outlet obstruction and urinary retention. In both cases, focal perforation was identified within diverticula. Bladder rupture in the absence of trauma is a rare and serious event with a mortality rate approaching 50%. These injuries are often initially misdiagnosed and it is our goal to provide insight to the presentation, management and treatment of this rare event.Key Words: Intraperitoneal bladder rupture, Bladder diverticulum, Spontaneous bladder rupture, Interposition omental flap, Extraperitoneal bladder rupture     

Spontaneous rupture of the urinary bladder--a late complication to radiotherapy. Case report

Spontaneous rupture of the urinary bladder is extremely rare. A case of spontaneous intraperitoneal rupture of the urinary bladder 18 years after radiation therapy for testis cancer is reported.     

Prenatal diagnosis of spontaneous bladder rupture in a female fetus

Spontaneous bladder rupture is a rare condition, with diagnosis more rare in the prenatal than postnatal period. To our knowledge, there have been 7 cases of prenatally diagnosed bladder ruptures and all have been males. We report the first case of prenatal diagnosis of spontaneous bladder rupture in a female fetus. After a primary Cesarean-section birth, a tear in the newborn infant bladder dome was identified and repaired in 2 layers. The cause of the bladder rupture remains unknown.     

Cas clinique: Peritonite aigue par rupture non traumatique de la vessie

Spontaneous bladder rupture (SBR) is rare. This entity occurs outside of any traumatic context. A 70 years-old man was admitted for acute peritonitis, acute urinary retention and hematuria. Laparotomy and exploration showed acute generalized peritonitis related to a centimeter hole in the bladder dome. Peritoneal lavage was done with biopsy of the perforation edges, a cystostomy and suturing of the bladder. The immediate postoperative course was uneventful. The etiological investigation revealed a locally advanced and metastatic prostate cancer. The evolution was rapidly fatal and the patient's death occurred two months later due to metastatic disease. The causes, diagnosis and treatment of SBR are reviewed by the authors.     

Substance abuse-related spontaneous bladder rupture: report of 2 cases and review of the literature

Spontaneous rupture of the normal bladder associated with alcohol abuse is rare, with only 20 cases reported in the English literature to which we add 2 cases. Heavy alcohol ingestion predisposes the bladder to rupture by the large volume of fluid intake, its diuretic effect and the mental obtusion it produces, clouding sensory cues to void. alpha-Sympathomimetic drugs, such as cocaine and methamphetamine, increase the resistance at the urethral sphincter and exacerbate the effects of alcohol. Cystography will be diagnostic, and prompt operative repair of intraperitoneal rupture is mandatory. Complete evaluation of the bladder, including urodynamic study, is important to eliminate underlying bladder pathological conditions. Substance abuse-related rupture demonstrates a typical constellation of clinical features that necessitate considering it a syndrome separate from other causes of spontaneous bladder rupture.     

Rare case of spontaneous rupture of a urinary bladder carcinoma causing intestinal obstruction and peritonitis

Spontaneous rupture of the urinary bladder is a rare condition, especially due to squamous cell carcinoma. Less than 10 cases have been reported so far. The patient was a 30‐year‐old male presenting with difficulty passing urine, dribbling, dysuria and right loin pain of 4 days duration and constipation for 2 days. He then developed features of intestinal obstruction with peritonitis. Laparotomy revealed advanced urinary bladder carcinoma adherent to the ileum and urine in the peritoneal cavity. There was a perforation of the urinary bladder separate from the area of adherence. Palliative surgery was performed. Histopathology report was squamous cell carcinoma. The present case is being reported, as it is a diagnostic dilemma and is a rare condition, this being only the seventh case reported in the literature. The mortality rate is high and even though the patient had postoperative problems, he survived.     

Rupture of urinary bladder secondary to bladder carcinoma with extensive abdominal gangrene: A case report

Introduction and importanceSpontaneous rupture of the urinary bladder is rare but potentially severe. It is unusually related to bladder tumours. The morbidity and mortality rate are very high in these groups of patients.Case presentationWe present a case of a 62-year-old man who was known to have a bladder tumour who presented with extensive gangrene of the anterior abdominal wall. Imaging showed an extraperitoneal urinoma extended to the anterior abdominal wall secondary to a bladder rupture with posterior bladder wall thickening suggesting a bladder tumour. After optimization of the patient’s condition, urinoma drainage and upper urinary tract drainage by bilateral nephrostomy, excision of all necrotic tissues and a biopsy of the bladder lesion was performed. At a multidisciplinary meeting, we opted for a transurethral resection of the bladder followed by palliative chemotherapy considering that the tumour was locally advanced and depending on the disease course and patient’s condition.Clinical discussionGangrene secondary to urinary bladder rupture caused by transitional cell carcinomas is a very rare disease with poor oncological and infectious prognoses. For these reasons, treatment is often palliative.ConclusionUrinary bladder rupture secondary to bladder carcinoma could rarely be complicated with abdominal gangrene. No standardized treatment is recommended seeing the extreme rarity of this disease and management should be discussed on a case-by-case basis.     

Pneumoperitoneum and peritonitis secondary to perforation of an infected bladder

Introduction and importanceSpontaneous urinary bladder rupture is a rare complication of urosepsis. Its co-occurrence with pneumoperitoneum is even more unusual.Case presentationA 73-year-old patient presented with acute retention with mild lower abdominal pain and difficulty with urinary voiding and cystitis. He was treated with bladder catheter and antibiotics. After one month, he suddenly developed peritonitis and shock. Pneumoperitoneum was observed on a chest x-ray. An emergent laparotomy was performed and a perforation of the bladder secondary to necrosis of part of the wall was found and resected. The patient recovered satisfactorily after the surgical intervention.Clinical discussionSpontaneous bladder rupture is a life-threatening condition that could be missed. Surgical intervention is mandatory to rule out other more probable causes of peritonitis and to manage the bladder perforation itself.ConclusionPneumoperitoneum is rarely secondary to a bladder perforation. Immediate surgical intervention is required in order to avoid delays in treating any intra-abdominal condition including a bladder wall perforation.     

Idiopathic spontaneous bladder rupture in an intoxicated patient

Spontaneous bladder rupture is a rare condition associated with significant morbidity and mortality. We describe a case that occured following a period of alcohol intoxication and presented as acute renal failure. The factors that contribute to this condition in an intoxicated person are outlined and useful clinical markers are suggested. This case demonstrates the difficulties with diagnosis and the need for a high index of suspicion.     

Spontaneous bladder rupture in a chronic hemodialysis patient

Spontaneous bladder rupture is very rare. A 67-year-old woman who was nearly anuric and had been on chronic hemodialysis therapy for diabetic end-stage renal disease for 6 years complained of severe low abdominal pain and fever for 2 days. Abdominal computerized tomography and retrograde cystography revealed the extraperitoneal leakage of contrast medium, confirming bladder perforation. Partial cystectomy around the perforation site and repair of the bladder rupture were performed. Microscopic examination of the excised bladder tissue revealed that the bladder mucosa was ulcerated. Severe suppurative inflammation was observed throughout the bladder wall. Antibiotic treatment was continued for 3 weeks postoperatively, and repeated retrograde cystography showed no evidence of contrast extravasation. She was discharged, with no other complications.     

Spontaneous bladder rupture following non traumatic vaginal delivery in a multiparous woman: A rare case report

IntroductionSpontaneous bladder rupture SBR is a rare condition and often missed diagnosis, especially after a nontraumatic vaginal delivery.Case presentationA 34-year-old patient who had a nontraumatic vaginal delivery presented to the emergency room 7 days later with acute abdomen and anuria. Computed tomography showed free fluid in the peritoneal cavity. An intraperitoneal rupture of the bladder dome was detected, showing extravasation of contrast into the peritoneal cavity. An exploratory laparotomy revealed a perforation on the bladder dome that was sutured.Clinical discussionSBR following vaginal delivery is an extremely rare condition. It represents a surgical emergency. Due to the low incidence and the presence of non-specific symptoms, diagnosis was usually delayed with an increased morbidity and mortality.Clinicians should consider this diagnosis in the presence of an acute abdominal pain associated to anuria or dysuria.We therefore recommend that the bladder be catheterized or drained before labour.ConclusionSBR is a rare and life-threatening condition in post-partum. Abdominal pain with elevated serum creatinine should be suspicious of urinary bladder rupture.     

Blasenruptur durch spontane Perforation einer infizierten Urachuszyste

Anomalies of the fetal urachus are rare. Normally, the postnatal urachus presents as a fibrous band extending from the bladder to the umbilicus. Urachal cysts may occur in postnatal life. Spontaneous perforation of urachal cysts is a very rare condition, which clinically may not be distinguishable from other acute abdominal conditions. We report a case of a 63-year-old male with a history of recurrent urinary tract infections and a bladder rupture caused by a spontaneous perforation of an infected urachal cyst. The symptomatology showed abdominal rigidity and pain, a palpable mass in the lower abdomen, and hematuria. Laboratory findings showed leukocytosis and an increased CRP level. The bladder rupture was confirmed by cystography. Bacteriologic examination identified Proteus vulgaris, Corynebacterium species, and Klebsiella pneumoniae. Most of the published cases in the literature report about intraperitoneal perforation of infected urachal cysts. In the present case, we found a spontaneous perforation of an infected urachal cyst leading to an extraperitoneal bladder rupture with an extraperitoneal limitation of the infection. The definitive therapy was complete surgical excision including a cuff of the bladder, drainage, and systemic broad-spectrum and local application of antibiotics. The further course was uneventful.     

Myocardial abscess with contained rupture: successful repair

Spontaneous rupture of the heart from myocardial abscess is a rare occurrence. Most cases of spontaneous cardiac rupture are due to myocardial infarction. We present a case of a contained rupture of the heart in a patient with staphylococcal septicemia. Although cultures from the pericardial space were negative the macroscopic and clinical picture was compatible with an abscess.     

Recurrent spontaneous rupture of the urinary bladder: a case report

The patient was a 67-year-old woman who had undergone radical hysterectomy and postoperative radiotherapy for cervical cancer at the age of 46 years. Spontaneous rupture of the urinary bladder occurred twice in 1997, and conservative treatment was performed on each occasion. She was admitted to our hospital for the third time of spontaneous rupture of the urinary bladder. She underwent bilateral cutaneous ureterostomy because of panperitonitis and paralytic ileus. A review of 11 cases of recurrent rupture of the urinary bladder reported in Japan including the present case revealed that, patients who had been conservatively treated tended to be subject to recurrence. However, the risk of recurrence remains when a partial cystectomy is performed. Therefore, especially in recurrent cases, augmentation cystoplasty or urinary diversion should be considered as the treatment for spontaneous rupture of the urinary bladder due to radiation cystitis.     

Recurrent spontaneous bladder rupture. A case report

Spontaneous (non-traumatic) intraperitoneal rupture of the bladder in a 37-year-old pregnant woman was repaired at laparotomy. Nine months later she again presented with an intraperitoneal bladder rupture during pregnancy and fatal sepsis. Histological examination of the resected bladder wall showed acute ulcerative and necrotising cystitis. All patients with apparently spontaneous bladder rupture should undergo full urological evaluation to identify possible disease which might lead to recurrent rupture.     

Neonatal bladder rupture: case report and review of literature

Neonatal bladder rupture is rare. A review of the literature revealed less than 16 cases. A case of posterior urethral valves and associated neonatal ascites due to bladder perforation is presented.     

Intravesical Explosion during Transurethral Resection of Prostate - a reminder

Intravesical explosion during transurethral resection of the prostate (TURP) is an extremely rare but dreaded complication and results in rupture of the bladder. It is believed that intravesical explosion occurs due to formation of explosive gases in the bladder during TURP and its admixture with air. A case of intravesical explosion during TURP resulting in bladder rupture at our institution is described. Though the management of this catastrophe is relatively straightforward, it has the potential for dire consequences. We emphasize that, despite its rare occurrence, it is preventable and suggest measures to avoid it.     

Ischemic necrosis: a hypothesis to explain the pathogenesis of spontaneously ruptured enterocystoplasty

Spontaneous enterocystoplasty rupture represents a devastating and potentially fatal late complication. Previously proposed mechanisms of rupture include catheter trauma, chronic infection, avulsion of adhesions between the bowel patch and peritoneum, and chronic overdistension with elevated intravesical pressures. We have witnessed this complication 4 times in 3 patients 5 weeks to 46 months postoperatively. Tissue specimens from 3 episodes in 2 patients with detubularized sigmoid enterocystoplasties were available for histological examination. All patients had a neurogenic bladder from myelomeningocele, all had an AMS800 artificial urinary sphincter and all had a documented history of chronic distension from inadequate emptying of the augmented bladder. At exploration, all of the ruptures were found within the bowel segment near the bladder apex in an area remote from the anastomotic line. In each case tissue specimens from the rupture site showed marked vascular congestion, intramural hemorrhage, abundant hemosiderin laden macrophages, myofiber atrophy and intravascular thrombi. These features are interpreted to reflect the sequelae of vascular compromise and ischemia. We propose that enterocystoplasty rupture results from ischemia, possibly due to chronic overdistension and subsequent vascular compromise. This mechanism may account for many of the previously reported cases of enterocystoplasty rupture.     

Fatal haemoperitoneum due to liver metastases from nasopharyngeal cancer

Spontaneous rupture of hepatic metastases is rare, there being only 22 cases documented in the literature. We report here the first such case due to nasopharyngeal carcinomatous metastases. This is of interest because in South East Asia ruptured hepatocellular carcinoma is the usual cause of spontaneous fatal haemoperitoneum.