A Case of Bladder Rupture Initially Misdiagnosed as Ascites Due to Alcoholic Liver Disease

Bladder rupture is a rare condition, typically associated with trauma but occasionally occurring spontaneously. Non-traumatic bladder rupture is particularly challenging to diagnose due to its non-specific symptoms. This case report presents a bladder rupture initially misdiagnosed as ascites due to alcoholic liver disease. A 59-year-old man presented with progressive abdominal distension without abdominal pain or urinary symptoms. His medical history included diabetes, asthma, dyslipidemia, and chronic alcohol consumption. Laboratory tests showed renal impairment but no significant liver dysfunction. Abdominal CT revealed ascitic fluid, leading to a diagnosis of alcoholic liver disease. He was hospitalized, and conservative treatment was started, but his renal function deteriorated. On the fifth day, however, after urinary catheterization, 10 L of urine were drained within six hours, resulting in a rapid decrease in serum creatinine levels. Retrospective review of imaging revealed a rupture at the bladder apex, likely caused by chronic bladder overdistension due to alcohol use and diabetic autonomic dysfunction. The patient recovered with conservative management, and a follow-up cystogram confirmed bladder healing. This case highlights the diagnostic challenge of non-traumatic bladder rupture, especially in the absence of typical symptoms. Clinicians should consider bladder rupture in patients presenting with unexplained ascites, renal impairment, and an unusual diuretic response to catheterization.