Spontaneous isolated intraperitoneal rupture of urinary bladder after normal vaginal delivery presenting as puerperal sepsis

Abstract

Spontaneous isolated intraperitoneal rupture of urinary bladder is a rare urological complication of normal delivery. This complication is usually related to prolonged labour, failure to empty bladder in second stage of labour, use of forceps/ ventouse, postpartum urinary retention, vaginal birth after caesarean section and usually presents immediately after delivery. We report the case of a patient with spontaneous isolated intraperitoneal rupture of urinary bladder after normal vaginal delivery in the absence of any risk factor. She presented on day 5 postpartum with features suggestive of puerperal sepsis with pyoperitoneum with acute kidney injury. Absence of unhealthy lochia and later, normal-looking uterus and adnexa during laparotomy led to the suspicion of alternate cause for seropurulent ascites. Further exploration revealed rent in the urinary bladder with necrosed margins. High index of suspicion of alternate diagnosis should be maintained if some of the clinical findings are not supportive of provisional initial diagnosis