Acute abdomen caused by bladder rupture attributable to neurogenic bladder dysfunction following a stroke: a case report

We report the case of a 67-year-old Caucasian man who presented with lower abdominal pain and a peritonitic abdomen. He had a long-term urethral catheter because of urinary retention following a previous stroke. He was treated conservatively with antibiotics before a surgical opinion was sought. Exploratory laparotomy confirmed the diagnosis of spontaneous bladder rupture. After repair of the defect, he eventually made a full recovery.In this unusual case report, we describe an example of a serious event in which delays in diagnosis may lead to increased morbidity and mortality. To date, no unifying theory explaining why rupture occurs has been postulated. We conducted a thorough literature search to examine the etiological factors in other published cases. These etiological factors either increase intra-vesical pressure or decrease the strength of the bladder wall. We hope that by increasing awareness of these etiological factors, spontaneous bladder rupture may be diagnosed earlier and appropriate therapy started.Spontaneous bladder rupture is a rare and serious event with a mortality rate approaching 50% [1]. It is often difficult to diagnose clinically, even with the aid of increased timely access to computed tomography (CT). A number of conditions are known to predispose patients to bladder rupture, including trauma, pelvic malignancy and subsequent radiotherapy, previous bladder surgery, pregnancy, and binge alcohol drinking. Patients normally present with one of these conditions and have a short history of severe lower abdominal pain. If intra-peritoneal rupture has occurred, patients present with peritonism and blood tests consistent with acute renal failure due to the intra-peritoneal resorption of urine. Retroperitoneal rupture may be treated conservatively, but otherwise surgery is often the only modality of treatment.A 67-year-old Caucasian man presented to our hospital after an accident and emergency with a history of five hours of sudden-onset lower ab