Recurrent Spontaneous Bladder Rupture with a Markedly Elevated Serum-ascites Albumin Gradient

Bladder rupture is a rare but potentially fatal condition that is often difficult to diagnose because of its nonspecific symptoms. A 75-year-old woman with a history of remote pelvic radiotherapy presented with abdominal pain, renal dysfunction, and ascitic fluid. Initially, NSAID-induced renal injury was suspected, and her condition improved after drug discontinuation. Recurrent symptoms led to the suspicion of bladder rupture, confirmed by elevated ascitic creatinine levels and cystography. Her serum ascites albumin gradient (SAAG) exceeded 3.0 g/dL. Although elevated SAAG levels are theoretically expected in patients with bladder rupture, this association remains hypothetical, and further investigation is warranted to clarify its diagnostic utility.