[
,: Vol. 116, November Printed in U.S.A.
THE JOURNAL OF UROLOGY
Copyright© 1976 by The Williams & Wilkins Co.
IDIOPATHIC RUPTURE OF THE BLADDER ROGER A. EVANS, RICHARD W. REECE
AND
M. J. V. SMITH
t·
From the Division of Urology, Medical College of Virginia, R ichmond, Virginia
ABSTRACT
Non-traumatic spontaneous rupture of the otherwise normal bladder is a rare occurrence. The literature is reviewed and 4 new cases are reported. Experimental data are presented and a theory is reviewed regarding the frequent intraperitoneal location of the rupture. The frequent paucity of symptoms compared to the high mortality rate is stressed. Spontaneous rupture of the bladder should be t hOJight...ofin 2 Drains were placed and a suprapubic tube was left indwelling. dist inct categories. It may occur in the pathologic bladder, that The peritoneal cavity was normal on exploration. Convalesis one with predisposing conditions such as tumor, tuberculo- cence was stormy but the patient recovered . Comment: The peritoneal tap had been exfraperitoneal sis, oost rucbon and so foi~:Y---he-a-£p.o.ll.t.ang_Q_us rupture of a normal bladder, or what we term idiop~thic secondary to marked obesity and drained an extravasated rupture of t he filadder This rare entity is clinically important pocket of urine. The hyperosmolar coma, with decreased because it occurs in all age groups and has a protean clinical consciousness and increased urinary output, likely contributed presentation that accounts for the frequent diagnostic delay to this idiopathic rupture. Interestingly, this rupture was and high mortality rate. 1 posterior but below the peritoneal reflection. Case 3. E. H ., 5283323, a 6-pound 11-ounce black boy, was During the last 10 years we have seen 4 cases of idiopathic rupture. These are discussed, the literature is reviewed and born vaginally without difficulty. When the child was 3 days old he was returned to the hospital because he had never experimental work is presented. voided. The abdomen was distended. The urea nitrogen was 51 CASE REPORTS and carbon dioxide was 12. An excretory urogram (IVP) Case 1. A 38-year-old white woman, 9538720, was seen in the revealed bilateral hydroureteronephrosis. Foley catheterization emergency room after having stumbled on the sidewalk. Severe lower abdominal pain and extreme urgency developed but the patient was unable to void. A Foley catheter was inserted but there was no return from the bladder. Physical examination revealed a patient in some pain but with normal vital signs. Obvious signs were present of an acute abdomen with guarding and rigidity, more marked in the lower portion of the abdomen. A cystogram revealed intraperitoneal rupture of the bladder. At exploration a 3 cm. tear in the posterosuperior aspect of the bladder was biopsied, debrided and closed in 2 layers. Comment: This patient denied any trauma when she stumbled. The abrupt Valsalva maneuver with_a..
,: Vol. 116, November Printed in U.S.A.
THE JOURNAL OF UROLOGY
Copyright© 1976 by The Williams & Wilkins Co.
IDIOPATHIC RUPTURE OF THE BLADDER ROGER A. EVANS, RICHARD W. REECE
AND
M. J. V. SMITH
t·
From the Division of Urology, Medical College of Virginia, R ichmond, Virginia
ABSTRACT
Non-traumatic spontaneous rupture of the otherwise normal bladder is a rare occurrence. The literature is reviewed and 4 new cases are reported. Experimental data are presented and a theory is reviewed regarding the frequent intraperitoneal location of the rupture. The frequent paucity of symptoms compared to the high mortality rate is stressed. Spontaneous rupture of the bladder should be t hOJight...ofin 2 Drains were placed and a suprapubic tube was left indwelling. dist inct categories. It may occur in the pathologic bladder, that The peritoneal cavity was normal on exploration. Convalesis one with predisposing conditions such as tumor, tuberculo- cence was stormy but the patient recovered . Comment: The peritoneal tap had been exfraperitoneal sis, oost rucbon and so foi~:Y---he-a-£p.o.ll.t.ang_Q_us rupture of a normal bladder, or what we term idiop~thic secondary to marked obesity and drained an extravasated rupture of t he filadder This rare entity is clinically important pocket of urine. The hyperosmolar coma, with decreased because it occurs in all age groups and has a protean clinical consciousness and increased urinary output, likely contributed presentation that accounts for the frequent diagnostic delay to this idiopathic rupture. Interestingly, this rupture was and high mortality rate. 1 posterior but below the peritoneal reflection. Case 3. E. H ., 5283323, a 6-pound 11-ounce black boy, was During the last 10 years we have seen 4 cases of idiopathic rupture. These are discussed, the literature is reviewed and born vaginally without difficulty. When the child was 3 days old he was returned to the hospital because he had never experimental work is presented. voided. The abdomen was distended. The urea nitrogen was 51 CASE REPORTS and carbon dioxide was 12. An excretory urogram (IVP) Case 1. A 38-year-old white woman, 9538720, was seen in the revealed bilateral hydroureteronephrosis. Foley catheterization emergency room after having stumbled on the sidewalk. Severe lower abdominal pain and extreme urgency developed but the patient was unable to void. A Foley catheter was inserted but there was no return from the bladder. Physical examination revealed a patient in some pain but with normal vital signs. Obvious signs were present of an acute abdomen with guarding and rigidity, more marked in the lower portion of the abdomen. A cystogram revealed intraperitoneal rupture of the bladder. At exploration a 3 cm. tear in the posterosuperior aspect of the bladder was biopsied, debrided and closed in 2 layers. Comment: This patient denied any trauma when she stumbled. The abrupt Valsalva maneuver with_a..
