Rare case of spontaneous extraperitoneal bladder rupture in an elderly bedbound female: a case report

Spontaneous bladder rupture (SBR) is a rare but life-threatening condition that typically occurs in the setting of bladder pathology, infection, or increased intravesical pressure. This case report aims to describe a rare presentation of spontaneous extraperitoneal bladder rupture in an elderly, immunocompromised, bedbound female-highlighting potential contributing factors such as Candida dubliniensis infection and chronic bladder dysfunction due to neurological impairment.

We present a case of an immunocompromised patient who developed SBR in the absence of prior urinary catheterization or overt bladder obstruction. Imaging revealed bladder wall rupture with bilateral hydronephrosis and free air loculus on the posterior of the bladder. Notably, the patient was found to have an occipital stroke, raising the possibility of an underlying neurogenic component contributing to chronic bladder dysfunction and subsequent rupture. Urine culture grew Candida dubliniensis, suggesting a potential role of fungal infection in bladder wall fragility, although definitive causation remains unclear. The patient's condition deteriorated despite multidisciplinary care, ultimately resulting in mortality.

This case underscores the diagnostic challenges of SBR in medically complex patients and highlights the importance of early imaging, particularly retrograde cystography, for prompt diagnosis. It also raises awareness of neurological impairment as a potential contributor to bladder dysfunction and rupture, necessitating vigilance in at-risk populations. Furthermore, the presence of Candida dubliniensis in a patient with SBR suggests a potential but unconfirmed role in bladder wall compromise. Clinicians should consider fungal infections and neurogenic bladder dysfunction in immunocompromised patients with unexplained bladder rupture, while recognizing the need for further research to determine causality.