Spontaneous Rupture of the Urinary Bladder Following a Night of Binge Drinking

Spontaneous rupture of the urinary bladder is a rare but potentially life‑threatening condition that often presents with non‑specific symptoms, leading to delayed diagnosis. We report a case of spontaneous intraperitoneal bladder rupture in a man in his 40s following acute bladder overdistension after binge alcohol consumption. The patient presented with lower abdominal pain, inability to pass urine, and elevated creatinine and lactate levels. Imaging revealed free intraperitoneal fluid and an intravesical haematoma. With clinical suspicion of spontaneous bladder rupture, an emergency laparotomy was performed, confirming a 15 cm rupture of the bladder dome. Primary two‑layer repair with drain placement was undertaken, and the patient made a full recovery, with an intact bladder demonstrated on post‑operative cystogram and successful catheter‑free voiding by day 18. This case highlights the importance of early recognition of spontaneous bladder rupture in patients presenting with acute abdomen, particularly following alcohol intake, and underscores key diagnostic pitfalls, including unreliable bladder scanner measurements and pseudo‑renal failure due to autodialysis. Prompt surgical intervention remains essential for intraperitoneal ruptures. Clinicians should also consider the potential contribution of bladder‑affecting medications, such as antimuscarinics, in precipitating rupture.