Bladder rapture as commonly misdiagnosed pathology - case report

Abstract

The non-traumatic urine bladder rapture is a very rare life-threatening condition. The diagnosis of this pathology provides many difficulties as the signs and symptoms are not specific and the role of some diagnostic methods is insufficient. We describe the case of 77-year-old male patient admitted to the Emergency Department due to dyspnea, breathing difficulties, urinary difficulties and significantly distended abdomen. The patient had numerous cardiovascular diseases, moreover the interview disclosed recently diagnosed stage III prostate cancer. The laboratory tests results suggested an acute kidney failure. Due to severe condition patient was transferred to the Intensive Care Unit (ICU), where intravenous treatment with ceftriaxone and metronidazole was done for the first 2 days. Afterwards therapy was modified by introducing tienam and vancomycin. On the 4th day of hospitalization the sudden deterioration in the patient's condition occurred and the abdominal US revealed free fluid in peritoneal cavity, which was not visible in previous examinations. The CT-cystography revealed connection between the bladder and the retroperitoneal space in the right part of anterior wall. Despite the urgent laparotomy, the patient died due to multiple organ dysfunction syndrome in the course of neoplastic process as cause.