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Spontaneous Intra-Peritoneal Urinary Bladder Rupture Complicating Benign Prostate Hyperplasia: Case Report

 

Ajape AA 1 FWACS, Abdulkadir AY 2 FMCR, Babata AL 1 FRCS, FWACS, Adesiyun OAM 2 FWACS(Rad). 1-Division of urology, Department of Surgery and 2-Department of Radiology, University of Ilorin Teaching Hospital, Ilorin. Nigeria. Correspondence: Dr.

 Ajape P.O. Box 4850, GPO, Ilorin. Nigeria. ajsnrkudimoh@yahoo.co.uk, ajsnrkudimoh@gmail.com +234-803-574-0982, +234-807-098-4355

Summary

A case of a rare atraumatic spontaneous rupture of the urinary bladder in a 62-year-old man with benign prostate hyperplasia who presented with anuria, abdominal pain and abdominal distension is reported. He had declined prostatectomy for two and a half years on financial ground. In addition to the presenting history, the presence of free intraperitoneal fluid and abdominal rigidity heightened the clinical suspicion of the diagnosis. This was confirmed by the laboratory demonstration of uroperitoneum and ultrasonographic demonstration of rent in the urinary bladder wall. About 6 litres of urine, mixed with blood, was drained following a moderately difficult trans-urethral bladder catheterization. This led to the spontaneous disappearance of the abdominal distension and healing of the bladder rupture as confirmed by ultrasonography and cystography on the eighth day of presentation. He had urethro-cystoscopy and retropubic prostatectomy electively two months later and has remained well on follow up.

Introduction

Spontaneous rupture of the urinary bladder is rare and commonly follows bladder wall pathology such as tu-mour, inflammation, wall weakness from over-disten-sion and outlet obstruction (1-6). The diagnosis may be missed because of non-pathognomonic presentations until at laparotomy, autopsy or during radiological work up (3). Laboratory findings are supportive. Radiological methods such as ultrasonography, contrast cystography and computed tomographic cystography are diagnos-tic (4). The treatment options include laparoscopic or open surgical repair (7). However, spontaneous healing can be achieved with trans-urethral continuous catheter drainage (11,12), as it was encountered in the case be-ing reported where the uncommon spontaneous intra-peritoneal bladder rupture followed an even more rare cause, benign prostate hyperplasia.

 

Case Report

A 62-year-old man presented at our Urology unit be-cause of progressive abdominal distension, abdominal pain and anuria of five days duration. He had initially gone into acute urinary retention (AUR) but the painful urge to micturate later abated. This was soon followed

 

by the abdominal distension and discomfort. He neither had history of trauma nor urethral instrumentation. He was not a known peptic ulcer disease patient and no in-gestion of non-steroidal anti-inflammatory drug. There was no fever or other constitutional symptoms.

 

He was a known patient, of the unit, who had histologi-cal confirmation of benign prostate hyperplasia two and a half years earlier, but declined prostatectomy on finan-cial ground.

 

Physical examination showed a middle-aged man in dis-tress. He was tachypnoeic and tachycardic with respira-tory rate of 34 cycles per minute and pulse rate of 124 beats per minute resp