Urinary Bladder Ruptures After a Long Party-night

Introduction: Urinary bladder rupture is a rare life-threatening event. Especially patients with alcohol intoxication are unable to provide a clear medical history. Physical examination often shows an acute abdominal pain. Under these circumstances, the diagnosis of a urinary bladder rupture requires a high index of suspicion.

Presentation of Case: After a long party night with consumption of alcohol, a 42-years old man wakes up with severe abdominal pain. Physical examination shows peritonitis- signs, especially in the lower abdominal part. Ultrasound detects free intraperitoneal fluid. The CT scan of the Abdomen shows perihepatic fluid. With the diagnosis of the acute abdomen without any radiological signs of perforation, we performed a laparotomy. Intraoperatively a 3x2 cm rupture of the superior wall is seen and closed with sutures. After the operation, the patient is received to the ICU.

Discussion: Urinary bladder rupture has a high mortality often due to late diagnosis. Spontaneous rupture of the urinary bladder is often associated with malignant disease, bladder outflow obstruction and neurogenic bladder. Alcohol-intoxicated patients are challenging cases in the emergency room. A clear history of the disease is not presented. In our case, the patient had no history of trauma or any known urological diseases. So, it is possible as reported previously in a few earlier cases that urinary retention in these cases may be due to rapid filling of the bladder secondary to the diuretic effect of alcohol. Moreover, nausea and vomiting might lead to enhanced intra-abdominal pressure and a higher probability of spontaneous bladder rupture.

Conclusion: Spontaneous rupture of the urinary bladder is a rare cause for acute abdominal pain with a high mortality because of delayed diagnosis. Especially Alcohol-intoxicated patients are not able to present any history of the disease. Moreover a urinary bladder rupture should be considered by patients with alcohol intoxication and without any traumatic event or known urological diseases as it is presented in our case.