Spontaneous bladder rupture mimicking a jejuno-ileal perforation

Area of Science:

• Urology
• Emergency Medicine
• Surgical Pathology

Background:

• Spontaneous urinary bladder perforation is an exceedingly rare condition.
• Trauma is the primary cause of bladder perforation, with idiopathic spontaneous rupture of urinary bladder (ISRUB) being exceptionally uncommon.
• Pre-operative diagnosis is challenging due to overlapping clinical, laboratory, and imaging findings with gastrointestinal perforations.

Observation:

• A 91-year-old male presented to the emergency department with acute abdominal symptoms.
• The patient's presentation closely mimicked that of a gastrointestinal perforation, specifically an ileal perforation.
• Initial diagnostic workup did not definitively identify the bladder as the source of the pathology.

Findings:

• The patient was diagnosed with spontaneous urinary bladder perforation.
• Intraoperative findings were crucial in differentiating the condition from suspected gastrointestinal perforation.
• This case underscores the difficulty in pre-operative diagnosis of ISRUB.

Implications:

• Highlights the importance of considering rare diagnoses in the differential for acute abdominal presentations.
• Emphasizes the need for high clinical suspicion and potentially advanced diagnostic modalities for spontaneous bladder perforation.
• Contributes to the limited case reports on ISRUB, aiding future diagnostic and management strategies.