Spontaneous urinary bladder perforation: An unusual presentation of well-differentiated papillary peritoneum
Armando Serao1, Francesca Ambrosini1,2, Barbara Cavallone1
1Department of Urology, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
Introduction:
Well-differentiated papillary mesothelioma (WDPM) is a very rare neoplasm. Most of WDPM are asymptomatic and are often incidentally detected during surgery. This report describes a case of WDPM of the peritoneum unexpectedly diagnosed in a male with a spontaneous intraperitoneal bladder rupture.
Case Presentation:
A 65-year-old male presented to our Emergency Department in November 2019 with a two-day history of anuria, abdominal pain, distention, and sepsis. The CT scan reported a large amount of extra and intraperitoneal free fluid. The CT cystogram showed bladder perforations on the dome and on the left lateral wall which was repaired through exploratory laparotomy. Intraoperatively, we encountered extensive suppurative peritonitis with large fibrino-purulent exudation. The purulent perivesical peritoneum was dissected and sent for histopathological examination which unexpectedly resulted in WDPM of the peritoneum.
Conclusion:
Although we can't affirm with certainty, this case would seem to suggest that WDPM had played a role in patient's clinical presentation. However, further research is necessary to draw stronger conclusion.
Insights
Well-differentiated papillary mesothelioma (WDPM) is a rare neoplasm. This case highlights its unexpected diagnosis in a patient with spontaneous intraperitoneal bladder rupture, suggesting a potential role in the presentation.
Area of Science:
- Oncology
- Pathology
Background:
- Well-differentiated papillary mesothelioma (WDPM) is an exceedingly rare neoplasm.
- WDPM is typically asymptomatic and incidentally discovered during surgical procedures.
Observation:
- A 65-year-old male presented with anuria, abdominal pain, distention, and sepsis.
- Imaging revealed extensive intraperitoneal fluid and bladder perforations.
- Exploratory laparotomy showed suppurative peritonitis with purulent exudation.
Findings:
- Histopathological examination of the perivesical peritoneum unexpectedly revealed WDPM.
- This diagnosis was made in the context of a spontaneous intraperitoneal bladder rupture.
Implications:
- This case suggests a potential, though unconfirmed, role of WDPM in the patient's clinical presentation.
- Further research is warranted to elucidate the relationship between WDPM and spontaneous bladder rupture.
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