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Updated: Jun 28, 2026
05:51
Diaphragmatic Ultrasound in Adults: Image Acquisition and Interpretation
Published on: January 31, 2025
Urological pathology causing free air under the diaphragm?
Sudhanshu Chitale1, Manash Debbarma, Patrick Wilson
1Department of Urology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK. chitalenorwich@aol.com
Annals of the Royal College of Surgeons of England
|November 8, 2008
Summary
A rare case of bladder cancer, initially presenting as a surgical emergency, highlights the importance of considering unusual diagnoses. Squamous cell carcinoma developed from long-standing bladder metaplasia, leading to spontaneous perforation.
Area of Science:
- Urology
- Oncology
- Pathology
Background:
- Keratinising squamous metaplasia of the bladder is a rare condition.
- Malignant transformation to squamous cell carcinoma can occur but is infrequently diagnosed pre-perforation.
Observation:
- A patient presented with acute peritonitis, mimicking a perforated peptic ulcer.
- This acute abdomen was caused by spontaneous perforation of an undiagnosed bladder tumor.
Findings:
- The tumor was a result of long-standing, undiagnosed, keratinising squamous metaplasia of the bladder.
- The perforation led to a critical surgical emergency.
Implications:
- This case underscores the need to consider bladder pathology in acute abdominal presentations.
- Early diagnosis of bladder squamous cell carcinoma, even in its metaplastic phase, is crucial for better outcomes.
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