Ascites Secondary to Spontaneous Bladder Rupture: A Case Report

Ascites is a common finding in clinical practice, typically originating from hepatic, malignant, cardiac, renal, or infectious diseases. However, other less frequent etiologies must be considered, making the medical history a critical component in establishing the diagnosis. Acute kidney injury is also frequently seen in the emergency department, arising from diverse causes, some of which may overlap with those of ascites. Late-onset bladder rupture is a rare but serious complication following pelvic radiation therapy. Delayed presentation can lead to diagnostic challenges and life-threatening consequences if unrecognized. We present the case of a 51-year-old female, with a history of cervical cancer treated with chemoradiotherapy 15 years earlier, who presented with progressive abdominal pain, distension, dysuria, and oliguria. Examination revealed a distended abdomen with a palpable fluid thrill. Laboratory findings showed acute kidney injury, leukocytosis, and metabolic acidosis. Initial imaging identified ascites and an empty bladder. After urinary catheterization drained over three liters in one hour, suspicion of bladder rupture arose. A contrast-enhanced CT cystogram confirmed the diagnosis. The patient underwent laparotomy for bladder repair. This case highlights the diagnostic challenge of spontaneous bladder rupture and the importance of considering this diagnosis in patients with a remote history of pelvic radiation. A high index of suspicion is essential in cases of unexplained ascites, acute kidney injury, and urinary abnormalities. Early recognition and surgical intervention are crucial for favorable outcomes.