A case of pseudorenal failure - spontaneous rupture of the urinary bladder

A 64-year old woman was admitted to the hospital for severe abdominal pain and distension after gardening and chopping wood the day before. She had a medical history of superficial transitional cell carcinoma (TCC) of the urinary bladder and a laparoscopic nefro-ureterectomy for an invasive TCC of the upper urothelial tract in 2012. Clinical examination showed an acute abdomen. Laboratory analysis revealed a plasma creatinine level of 4,23 mg/dl. Computed tomography (CT) imaging of the abdomen showed hypodense free intraperitoneal fluid, suspicious for ascites. Serum creatinine level decreased to 1.8 mg/dl after placement of a urinary catheter. Laparoscopic exploration revealed a perforated ulcer in the urinary bladder dome, the intraperitoneal fluid showed abnormally high levels of urea and creatinine, confirming uroperitoneum. This case shows that uroperitoneum must be in-cluded in the differential diagnosis of patients with diffuse/acute abdominal pain, abdominal distension and elevated levels of serum creatinine, and that vigilance is indicated.