Intraperitoneal spontaneous rupture of the urinary bladder associated with contracted bladder secondary to radiotherapy

A 57-year-old female was hospitalized in the gynecology ward of this hospital complaining of severe lower abdominal pain and abdominal distension. After admission, the abdominal pain disappeared immediately. She had undergone radical hysterectomy and postoperative radiotherapy for cancer of the uterus 7 years previously. Abdominal ascites was seen upon physical examination and an increase in serum BUN and creatinine were found in laboratory studies. Following urethral catheter drainage, abdominal distension and high level BUN and creatinine improved. She was sent to our urology department. We performed a retrograde cystogram and an intraperitoneal rupture of the bladder was diagnosed. A urethral catheter was left indwelling and she was discharged. A repeat cystogram revealed that the bladder was intact. The patient has been observed for 14 months without evidence of a ruptured bladder. Literature concerning spontaneous rupture of the bladder is briefly reviewed. (author)