Acute Peritonitis Due to Spontaneous Bladder Rupture

Spontaneous bladder rupture is a rare condition. Inflammation and chronic infection are the main contributing factors. Perforation secondary to a bladder tumor is much more rare and it poses a real diagnostic and therapeutic problems. We report a rare case of an elderly patient of 50 years old man chronic smoker of about (40 packs per year) with a history of recurrent low urinary tract infections, a trans-urethral bladder tumor resection on 13 June 2019. Endoscopic exploration: large infiltrating tumor at the level of the posterior and lateral wall with histopathological study confirming transitional cell carcinoma (urothelial carcinoma) infiltrating the detrusor muscle classified PT2 high grade. The patient received 8 sessions of radiotherapy and 5 sessions of chemotherapy. Admitted for bladder tumor complicated with acute peritonitis. The patient had consulted at the emergency department for an acute abdomen, in which the clinical examination found a conscious patient, slightly discolored conjunctiva, febrile at 38°C with diffusely abdominal pain, tensing abdominal and a pain of pouch of Douglas by rectal examination. Laboratory result findings a hyperleukocytosis of 15000 elements/mm3, CRP at 35 mg/l and renal insufficiency with estimation of the glomerular filtration flow rate (GFR):18 ml/min/1,73 m2. The abdomino-pelvic ultrasound shows a peritoneal effusion of a little abundance. Abdomino-pelvic CT scan was requested, which had shown a pneumo-peritoneum with bladder perforation. The patient was urgently taken to the emergency room for an exploratory laparotomy with an extensive peritoneal lavage and suture of the bladder wound after removal of all necrotic margins with urinary diversion by bladder catheterisation. A thoraco-abdomino-pelvic scan was performed later and showed pulmonary and hepatic metastases of a secondary origin indicating a palliative treatment.

Spontaneous urinary bladder rupture is a rare emergency which can may be misdiagnosed as gastrointestinal tract perforation. It should be suspected in patients with acute abdomen with a history of bladder tumor.