American Journal of Case Reports最新文献

{"title":"Vertebral Artery Dissection Induced by Fitness Video Game Exercise: A Case Report.","authors":"Hiroyuki Tokue, Azusa Tokue, Yoshito Tsushima","doi":"10.12659/AJCR.950188","DOIUrl":"10.12659/AJCR.950188","url":null,"abstract":"<p><p>BACKGROUND Vertebral artery dissection (VAD) is an important cause of ischemic stroke in young adults and is often associated with mechanical stressors such as trauma, sudden neck movements, or intense physical activity. While video games are not traditionally recognized as a risk factor, the increasing popularity of interactive fitness games calls for attention to their potential health implications. CASE REPORT We present the case of a 25-year-old sedentary woman with no vascular risk factors who developed acute left-sided neck pain while performing repetitive overhead pushing and pulling movements using a resistance-based controller during gameplay with Ring Fit Adventure (Nintendo Co., Ltd.), a home fitness video game. Two days later, she experienced sudden-onset left-sided numbness and visual disturbance. Neurological examination revealed left homonymous hemianopia and hemisensory deficits. Brain MRI revealed an acute infarct in the right occipital lobe, and magnetic resonance angiography showed right posterior cerebral artery occlusion and dissection of the left vertebral artery with intramural thrombus. She underwent successful endovascular thrombectomy and intra-arterial thrombolysis, followed by dual antiplatelet therapy. Her symptoms improved markedly, and she was discharged with only mild visual field defect. Imaging at follow-up demonstrated vascular remodeling. No underlying vasculopathy or prothrombotic condition was identified. CONCLUSIONS This case highlights that even a seemingly benign fitness video game may exert sufficient mechanical stress to trigger VAD, particularly in untrained individuals. While the temporal association suggests a potential link, causality cannot be definitively established. As home fitness gaming becomes increasingly popular, it is important for both clinicians and the general public to be aware of rare but serious vascular complications that may arise from sudden, strenuous activity in previously sedentary individuals.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e950188"},"PeriodicalIF":0.7,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12447776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right Hepatic Lobe Hypoplasia and Gangrenous Cholecystitis: Surgical Implications and Case Report.","authors":"Mohamad Ayham Muqresh, Sandrella I Zebian, Abdulkarim M Alkadrou, Osama Al-Shoaib, Thamer Bin Traiki","doi":"10.12659/AJCR.948437","DOIUrl":"10.12659/AJCR.948437","url":null,"abstract":"<p><p>BACKGROUND Hypoplasia of the right hepatic lobe is a rare congenital anomaly often discovered incidentally during imaging or surgery. This anomaly can be challenging during surgery, leading to intraoperative complications. Patient with right hepatic hypoplasia usually live normally without symptoms, but it can be associated with liver cirrhosis, portal hypertension, and gallstones. While the exact pathophysiological relationship between congenital hepatic hypoplasia and cholecystitis remains unclear, a few contributing factors have been proposed. These include mutations in the hepatocyte nuclear factor 1B (HNF1B) transcription, impaired gallbladder function, and gallbladder ischemia due to malposition. CASE REPORT A 70-year-old man presented with gangrenous cholecystitis and concurrent hypoplasia of the right hepatic lobe; a combination not previously documented. The patient, initially asymptomatic, presented with sharp epigastric pain and was diagnosed with acute cholecystitis through abdominal ultrasound. However, computed tomography (CT) imaging showed severe hypoplasia of the right liver lobe with associated compensatory hypertrophy of the left lobe in addition to stones in the gallbladder. Despite normal laboratory results, we think that the anomaly delayed the diagnosis until the development of cholecystitis as a complication. The patient underwent a successful laparoscopic cholecystectomy without converting to open surgery. CONCLUSIONS This case underscores the importance of recognizing anatomical variations when planning surgery. Awareness of right hepatic lobe hypoplasia can aid in timely diagnosis and appropriate management, ultimately reducing surgical risks and complications. Furthermore, we recommend performing CT in case of vague or atypical symptoms of acute cholecystitis, as well as when the gallbladder shows malposition on abdominal ultrasound (US). However, we recommend identifying the anatomical structure during the surgery to avoid complications.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e948437"},"PeriodicalIF":0.7,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12445154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Complex Anal Fistula in Recurrent Perianal Abscess: A Case Report.","authors":"Mingzi Zhang, Wei Wang, Yijun Xia, Huaqing Zhang, Yue Du, Zhi Wang, Xiao Long","doi":"10.12659/AJCR.948682","DOIUrl":"10.12659/AJCR.948682","url":null,"abstract":"<p><p>BACKGROUND Perianal abscesses are acute suppurative infections in perianal soft tissues or spaces, frequently associated with Crohn's disease, malignancies, diabetes, immunosuppression, or prior anorectal procedures. Persistent or recurrent infections following incision and drainage (I&amp;D) with standard wound care may indicate occult anal fistulas, necessitating thorough evaluation. CASE REPORT A 32-year-old woman presented with acute right buttock/thigh swelling, pain, and hypotension, initially diagnosed as septic shock. No predisposing factors were identified. Initial management included antibiotics and CT-guided drainage, resolving symptoms temporarily. One month later, she developed recurrent fever, chills, and a subcutaneous abscess. Repeated evaluations revealed no fistula; I&amp;D with vacuum sealing drainage (VSD) and plastic surgery-led wound closure achieved transient improvement. Three months postoperatively, purulent discharge recurred. Persistent symptoms prompted referral to a colorectal hospital. Rectal MRI identified a high complex-type anal fistula, confirmed surgically. Definitive fistula repair led to complete resolution. CONCLUSIONS Recurrent perianal infections, particularly in diabetics or obese patients, require vigilance for occult fistulas. This case highlights the bidirectional relationship between abscesses and fistulas, emphasizing that negative initial evaluations do not exclude fistula formation. MRI demonstrates superior diagnostic accuracy for complex fistulas and should be prioritized in refractory cases. Repeated drainage without addressing underlying fistulous tracts lacks long-term effectiveness. Early multidisciplinary collaboration and definitive surgical intervention are critical for sustained recovery. Specialized imaging and timely referrals optimize outcomes in diagnostically challenging scenarios.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e948682"},"PeriodicalIF":0.7,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12445932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guillain-Barré Syndrome Secondary to Snake Bite: A Report of a Rare and Fatal Case.","authors":"Parth Mukeshbhai Dhamelia, Dipak R Mokariya, Jaspreet Singh Anand, Pragyat Futela, Aleksandra Murawska Baptista, Abhinav Singla","doi":"10.12659/AJCR.948917","DOIUrl":"10.12659/AJCR.948917","url":null,"abstract":"<p><p>BACKGROUND Guillain-Barre syndrome (GBS) is a rare disorder arising due to immune-mediated damage to the peripheral nervous system. It most commonly occurs as a sequela of respiratory or gastrointestinal infections; however, in rare instances, cases may arise after snakebite envenomation. Several variants of GBS have been identified, with acute inflammatory demyelinating polyneuropathy (AIDP) being the most common, including our case. Other forms, such as acute motor axonal neuropathy (AMAN), are also more prevalent in tropical regions of Southeast Asia, as well as Central and South America. CASE REPORT A 52-year-old farmer from rural northern India presented with ascending palsy progressing for the past 3 days, along with bulbar symptoms and respiratory involvement for 1 day. He had been recently hospitalized a few weeks ago for snake-bite-associated neuroparalysis that had gradually resolved without any complications before discharge. Laboratory investigations and chest X-ray on presentation were suggestive of aspiration pneumonia, leading to initiation of empiric antibiotics. A diagnosis of AIDP variant of GBS was reached on the second day of admission, based on CSF studies showing albuminocytologic dissociation, and nerve conduction studies suggestive of axonal neuropathy in lower-limb nerves, and demyelination that was more pronounced in the lower limbs than in the upper limbs. He subsequently received a dose of IVIG, and was intubated for mixed hypoxic-hypercapnic respiratory failure. However, the worsening hemodynamic instability due to sepsis and GBS-related autonomic dysfunction, despite the antibiotic escalation and vasopressor support, eventually culminated in death. CONCLUSIONS This case underscores the importance of recognizing Guillain-Barre syndrome (GBS) as a neuroimmune sequela of snakebite envenomation, and the need for close neurological monitoring, patient and caregiver education, and physician awareness for early symptom recognition, and prompt initiation of empiric treatment to avoid delayed diagnoses and subsequent fatal complications.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e948917"},"PeriodicalIF":0.7,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12442504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giant Intra-Abdominal Tumor, Compatible with Liposarcoma: A Case Report and Literature Review.","authors":"Niu Dai, Juzheng Yuan, Xiaoyi Wang, He Bai, Haohao Ding, Xiao Li, Shuqiang Yue","doi":"10.12659/AJCR.948952","DOIUrl":"10.12659/AJCR.948952","url":null,"abstract":"<p><p>BACKGROUND We report a case of a giant (55×35×27 cm, 26 kg) retroperitoneal liposarcoma (RPLS) to provide surgical insights for managing such complex tumors. Due to the potential space in the retroperitoneal cavity, primary retroperitoneal liposarcoma can grow to very large sizes without causing typical symptoms, frequently encasing critical vessels and organs and making resection highly challenging. Most chemotherapy drugs have limited effectiveness against RPLS, while radiotherapy dosages are significantly constrained by toxicity concerns. These limitations underscore why complete surgical resection (R0) continues to be the cornerstone of RPLS treatment and the single most important prognostic factor. While R0 resection remains the primary treatment, innovative approaches are needed to improve outcomes. CASE REPORT A 59-year-old man came for medical treatment due to the continuous growth of an abdominal mass for 2 years. Imaging revealed tumor encasement of the left renal vessels and descending colon, with compression of the aorta and inferior vena cava. Following multidisciplinary evaluation, vascular-oriented resection (VOR) combined with total retroperitoneal lipectomy (TRL) was performed, achieving complete tumor removal along with the involved left kidney and partial colon. Pathology confirmed dedifferentiated liposarcoma (MDM2/CDK4+, Ki-67 10-30%). Postoperatively, the patient showed significant improvement, with resolved lower-limb edema and dyspnea. CONCLUSIONS This case demonstrates the feasibility of VOR combined with TRL for giant retroperitoneal liposarcoma, highlighting the importance of preoperative 3D vascular reconstruction and multidisciplinary collaboration. Although surgical techniques have advanced, the 5-year recurrence rate remains unacceptably high at nearly 50%, highlighting the urgent need to explore more effective adjuvant therapies.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e948952"},"PeriodicalIF":0.7,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12442506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated Sensorineural Hearing Loss as the Sole Manifestation of Granulomatosis with Polyangiitis.","authors":"Alejandro Arango, Sehreen Mumtaz, Andy Abril","doi":"10.12659/AJCR.948700","DOIUrl":"10.12659/AJCR.948700","url":null,"abstract":"<p><p>BACKGROUND Granulomatosis with polyangiitis (GPA) is a rare systemic vasculitis of small vessels associated with anti-neutrophil cytoplasmic antibodies (ANCA), typically affecting the respiratory tract and kidneys. Otologic involvement is relatively common, yet sensorineural hearing loss (SNHL) as the initial and sole clinical manifestation is exceptionally rare. Most reported cases of isolated SNHL in GPA involve unilateral or fluctuating hearing loss. Progressive bilateral SNHL associated with positivity for ANCA targeting proteinase 3 (PR3-ANCA), in the absence of systemic or ocular involvement, is rarely described in the literature. CASE REPORT A 36-year-old man with no significant medical history presented with sudden-onset left-sided SNHL, which was partially responsive to oral corticosteroids. Four weeks later, he developed bilateral hearing loss, tinnitus, aural fullness, and non-disabling postural instability. Audiometry revealed moderate-to-profound bilateral SNHL. Infectious and hematologic causes were ruled out. Laboratory tests showed positive PR3-ANCA, negative antinuclear antibodies (ANA), and mildly elevated inflammatory markers, including an erythrocyte sedimentation rate of 31 mm/h and a C-reactive protein level of 9.6 mg/dL. Head MRI was unremarkable, and no ocular, nasal, pulmonary, or renal involvement was found. A diagnosis of GPA with isolated inner ear involvement was made. Treatment with corticosteroids and rituximab led to symptom stabilization. CONCLUSIONS This case highlights an unusual presentation of GPA with PR3-ANCA positivity and progressive bilateral SNHL as the sole manifestation. Early recognition of atypical GPA presentations is essential to prevent irreversible hearing loss. Clinicians should consider ANCA-associated vasculitis in patients with unexplained bilateral SNHL, even in the absence of systemic signs. Early immunosuppressive therapy may preserve auditory function.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e948700"},"PeriodicalIF":0.7,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145055994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Erector Spinae Plane Block for Postoperative Analgesia After Intestinal Resection and Hernia Repair Surgery: A Case Report.","authors":"Gundega Ose, Irina Evansa, Edgars Krivmanis, Natalija Zlobina, Sergejs Klimcuks, Indulis Vanags, Olegs Sabelnikovs, Alain Borgeat","doi":"10.12659/AJCR.949259","DOIUrl":"10.12659/AJCR.949259","url":null,"abstract":"<p><p>BACKGROUND Erector spinae plane block is a reliable and efficient analgesic method that can be used when alternatives are ineffective or impractical, and is a possible alternative to epidural anesthesia. This case report details the effective implementation of a continuous bilateral erector spinae plane block in a post-laparotomy patient, addressing the clinical complexities associated with the patient's polymorbidity and, notably, the main challenge of reinitiating anticoagulants postoperatively. CASE REPORT A 64-year-old man was scheduled for a major anterior abdominal wall hernioplasty. The surgery revealed severe complications from the previous hernioplasty, necessitating intestinal resection, and because of the ischemic changes in the sigmoid colon, a sigmoid resection with the creation of anastomoses was performed in addition to the scheduled hernioplasty. After the surgery, the patient was transferred to the Intensive Care Unit (ICU), with severe postoperative pain. Two catheters were placed bilaterally at the Th11 level for erector spinae plane blockade, and a 0.125% bupivacaine infusion was initiated at a rate of 5 ml/h. Despite the need for immediate application of anticoagulants due to the comorbidities of the patient, no complications associated with catheters occurred during the postoperative period. CONCLUSIONS The use of a prolonged ESP block with bilateral catheter insertion is a reliable and efficient approach for providing long-term pain relief in patients following extensive abdominal surgery.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e949259"},"PeriodicalIF":0.7,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progressive Vision Loss From Uveal Melanoma with Extraocular Extension: A Case Report.","authors":"Ana Paula F C Tupynambá, Heloisa Lima Heller, Maria Fernanda L Britto, Isabella F Macedo, José A G Torres Junior, Valéria L C Borges, Ana Beatriz C Vieira, Renata Batista Ostrowski, Gustavo Henrique Soares Takano, Leonardo C G B Oliveira","doi":"10.12659/AJCR.947979","DOIUrl":"10.12659/AJCR.947979","url":null,"abstract":"<p><p>BACKGROUND Uveal melanoma is the most common primary intraocular malignancy in adults, often diagnosed late in resource-limited settings. The diagnosis is made through a combination of clinical ophthalmologic examination, B-mode ultrasound, and histopathological study. This report details a case of a 67-year-old woman with progressive vision loss and ocular pain due to an inferomedial uveal melanoma to highlight therapeutic limitations from delayed diagnosis. CASE REPORT A 67-year-old woman presented with 3 years of progressive vision loss, ocular pain, and a pigmented inferomedial lesion in the right eye. Examination revealed light perception vision, intraocular pressure of 38 mmHg, and a conjunctival mass with feeder vessels. Ultrasound showed a large choroidal tumor occupying 70% of the vitreous. Enucleation confirmed a 19-mm-thick mixed-cell uveal melanoma (T4a per American Joint Committee on Cancer 8th edition) with scleral invasion. Postoperative computed tomography (CT) revealed no metastases. CONCLUSIONS Delayed presentation led to enucleation as the only viable treatment. This case underscores the critical need for public awareness, early detection, and effective referral systems of pigmented ocular lesions to preserve vision, expand therapeutic options, and ensure timely access to specialized care.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947979"},"PeriodicalIF":0.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombotic Challenges at High Altitude: A Case Report of Cerebral, Pulmonary, and Ventricular Thrombosis in a 21-Year-Old.","authors":"ZhiXin Gan, JiaLin Wu, JingDu Tian, XiaoLi Han, Lei Zhang, Xi Yang, XiaoBo Han","doi":"10.12659/AJCR.948145","DOIUrl":"10.12659/AJCR.948145","url":null,"abstract":"<p><p>BACKGROUND At high altitude, reduced oxygen pressure and compensatory physiological mechanisms lead to increased blood viscosity and edema. This report describes the case of a 21-year-old man working at high altitude for 3 days who developed cerebral venous sinus thrombosis, pulmonary thromboembolism, and right ventricular thrombosis. CASE REPORT A 21-year-old man developed sore throat, cough, vomiting, and diarrhea on the 3rd day after rapidly ascending to a high altitude. After 3 days of anti-infective treatment with minimal effect, he experienced headache, seizures, dizziness, and blurred vision on the 7th day. He was ultimately diagnosed with cerebral venous sinus thrombosis (CVST) complicated by pulmonary thromboembolism (PTE) and right ventricular thrombosis. After 6 months of treatment with low-molecular-weight heparin and warfarin, his prognosis was good. CONCLUSIONS This report shows the rapid progression of multiple thrombotic events at high altitude and the approaches to diagnosis and management.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e948145"},"PeriodicalIF":0.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiotherapy-Related Bladder Fistula: A Hidden Cause of Recurrent Abdominal Symptoms.","authors":"Xiaofeng Ren, Jialin Wu, Shaobin Yang, Yuliang Wang, Yajun Xu, Chuan-Guo Guo","doi":"10.12659/AJCR.948953","DOIUrl":"10.12659/AJCR.948953","url":null,"abstract":"<p><p>BACKGROUND Non-traumatic bladder rupture, a rare yet potentially life-threatening condition, can stem from diverse factors such as malignancies, bladder inflammation, or bladder diverticulum rupture. Pelvic radiotherapy, in extremely rare instances, can lead to radiation cystitis and subsequent bladder fistula formation. Patients with such conditions often present with abdominal pain, hematuria, oliguria, and urinary ascites. The diagnosis of radiotherapy-related bladder fistula poses significant challenges, particularly in patients with protracted illnesses and atypical abdominal symptoms, as it can be easily overlooked. CASE REPORT We present the case of a 60-year-old woman who, 14 years following a hysterectomy, bilateral adnexectomy, and radiotherapy for cervical carcinoma, developed recurrent abdominal pain and ascites. Initially, her symptoms were misattributed to gastrointestinal disorders. However, ascites analysis, which revealed markedly elevated creatinine and urea nitrogen levels in the ascitic fluid compared to serum, led to the suspicion of urinary ascites. The definitive diagnosis of an intermittent bladder fistula was confirmed through the instillation of a saline-methylene blue solution via the urinary catheter, which resulted in the drainage of blue ascitic fluid. CONCLUSIONS The diagnosis of vesical fistula is often challenging due to its diverse presentations and the possibility of being overlooked by CT. However, early recognition and appropriate management are crucial to prevent severe complications. This case highlights the importance of considering bladder fistula in the differential diagnosis of unexplained ascites and peritonitis, especially in patients with a history of pelvic radiotherapy or cystoscopic treatment.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e948953"},"PeriodicalIF":0.7,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12442326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}