Spontaneous rupture of the urinary bladder with acute hepatic and renal failure: a case report

Background

Spontaneous rupture of the urinary bladder (SRUB) is a rare but life-threatening emergency that often presents with nonspecific symptoms, leading to delayed diagnosis and severe complications such as peritonitis, sepsis, and multi-organ failure. In rare cases, SRUB may present with multiorgan dysfunction including acute liver and kidney failure, complicating management and recovery. It is commonly associated with underlying bladder dysfunction, including chronic urinary retention and bladder outlet obstruction.

Case presentation

We report a 58-year-old male with a history of benign prostatic hyperplasia (BPH) who presented with acute abdominal pain, fever, jaundice, and hemodynamic instability. Laboratory tests revealed leukocytosis, renal impairment, metabolic acidosis, and hyperkalemia, as well as elevated bilirubin and liver enzyme levels. Abdominopelvic CT with cystography confirmed SRUB, showing contrast extravasation. The patient underwent an urgent exploratory laparotomy, which revealed two bladder tears that were successfully repaired. Postoperative care included broad-spectrum antibiotics, hemodialysis, and intensive monitoring, leading to a full recovery.

Discussion

SRUB is often misdiagnosed due to its resemblance to gastrointestinal and renal pathologies. This case highlights the importance of a high index of suspicion in patients with risk factors such as bladder outlet obstruction. CT cystography is crucial for early diagnosis, while surgical repair remains the gold standard for treatment. Supportive care, including hemodialysis and infection control, is vital for optimizing outcomes.

Conclusion

Early recognition and prompt surgical intervention are critical in managing SRUB. Clinicians should consider this rare condition in patients with acute abdomen and known bladder dysfunction to reduce morbidity and improve prognosis.