Spontaneous rupture of the urinary bladder following hemorrhoidectomy: A case report

Spontaneous rupture of the urinary bladder (SRUB) is a rare urological emergency. SRUB often results from over-distension due to acute urinary retention (AUR), which is more common in males but can also occur in females, particularly after surgeries like hemorrhoidectomy. This case highlights SRUB in a woman following hemorrhoidectomy, a rare complication that requires early recognition and management.

A 42-year-old woman presented with abdominal pain and obstructive urinary symptoms after undergoing hemorrhoidectomy. She had no prior abdominal trauma or gastrointestinal symptoms. Initial examination revealed abdominal distention and suprapubic dullness. A Foley catheter was inserted, providing temporary relief. Laboratory findings showed a significant rise in serum creatinine (6.2 mg/dL). CT cystography confirmed an intraperitoneal bladder rupture. The patient underwent open surgery, and her postoperative recovery was uneventful, with a return to normal creatinine levels.

SRUB can be associated with anorectal surgeries like hemorrhoidectomy, where iatrogenic nerve injury leads to AUR. The bladder retention can cause an increase in intra-vesical pressure, ultimately resulting in rupture. Early diagnosis is critical, as symptoms may be nonspecific. While ultrasonography provides some clues, CT cystography is the gold standard for diagnosis. Timely surgical intervention for intraperitoneal ruptures prevents life-threatening complications.

SRUB following hemorrhoidectomy is a rare but serious complication. Clinicians should consider SRUB in patients presenting with urinary symptoms, abdominal pain, and elevated creatinine level in the absence of hydronephrosis after pelvic surgeries.