Delayed Presentation of Traumatic Intraperitoneal Rupture of Urinary Bladder

Blunt injury of the urinary bladder is well known and usually associates pelvic fractures. Isolated bladder injury is a rare condition and on the other hand, delayed bladder perforation is an extremely rare entity. Herein, we described an unusual case of isolated delayed intraperitoneal bladder rupture that occurred on the third post injury day in a young male in the absence of free intraperitoneal fluid and pelvic fracture. The diagnostic workup, course and the need for surgical repair of the injury is presented. 1. Introduction Around 60% to 85% of all bladder injuries result from blunt abdominal trauma (BAT) but the incidence of intraperitoneal urinary bladder (UB) rupture is relatively uncommon from blunt injuries [1]. Isolated UB rupture following blunt trauma has an insidious presentation, and often results in delayed diagnosis and management [2–8]. The mechanism of injury include sudden compression of the full bladder, shear forces, or a pelvic fracture [2, 3, 9]. Rupture of bladder may be presented with lower abdominal pain, inability to void, and perineal ecchymoses [3]. The cardinal sign of injury to the bladder is gross hematuria [6], which is present in more than 95% of cases, while only about 5% of the patients have microscopic hematuria alone [6, 7]. Over 80% of the patients with UB rupture had an associated pelvic fracture in centers with high percentage of blunt trauma. On the other hand around 6% of patients with pelvic fracture sustain a bladder injury [3, 6]. Diagnosis of bladder injury, several days after admission, could be either a missed diagnosis or a truly delayed rupture. Delayed diagnosis of bladder rupture may be associated with laboratory abnormalities such as metabolic derangements, and leukocytosis. Delay in the presentation and treatment may substantially increases mortality [7–10]. Therefore, early and accurate diagnosis with imaging techniques is imperative. Computed tomographic cystography (CTC) and/or retrograde cystography (RGC) are the standard imaging tools for the diagnosis of bladder injury [4–10]. We present a case of delayed rupture of UB due to blunt trauma without associated injuries. 2. Case Report A twenty three-year old male patient sustained BAT due to fall from a 3-meter height. Initial vital signs were: blood pressure136/80？mmHg, heart rate 64？BPM, respiratory rate 20 per minute, oxygen saturation of 100% on room air, and temperature of 36.9°C. Patient was fully conscious with neither external bleeding nor neurological deficits. Abdominal examination showed mild generalized tenderness and voluntary