Spontaneous intraperitoneal rupture of the bladder

Spontaneous intraperitoneal rupture of the bladder (also called unsuspected, idiopathic, or non-traumatic rupture of the bladder) is a well defined but rare condition which has not been universally recognized in the past. We are reporting four cases and emphasizing its clinical picture so it might be better recognized and diagnosed early on in the process, and so that its management be planned appropriately in order to reduce its morbidity and its mortality. A review of the literature is provided to help achieve this end. Spontaneous intraperitoneal vesical rupture is almost always a surprise at laparotomy. A high degree of suspicion, the finding of urea in the ascitic fluid, and cystography may help in the diagnosis. Symptoms include abdominal pain, difficulty in micturition, hematuria and renal failure with elevation of the blood urea and acidosis. The etiology seems to be varied and somehow confused. We discuss four groups of etiological factors: dulled sensorium, weakening of the bladder wall, increased intra-vesical pressure (with or without bladder outlet obstruction) and vascular lesions (radiotherapy, arterial embolism and vesical infarction); and we try to discern common denominators for these four groups of etiological factors: an increase in intravesical pressure along with a weakening of the bladder wall. Finally the new concept of vesical infarction following ischemia due to overdistention of the bladder is introduced and discussed.