A Case of Partial Cystectomy for Spontaneous Intraperitoneal Rupture of the Bladder Revealed from Hemorrhagic and Septic Shock

A 81 - year - old man was transported to the emergency department of nearby hospital due to macroscopic hematuria, abdominal pain, and difficulty moving. When he arrived at the hospital, his blood pressure was decreased and he was in critical condition due to shock. Computed tomography (CT) showed that the bladder was filled with blood clots and ascites retention was recognized. Hemorrhagic and septic shock due to bladder hemorrhage was suspected. After admission, his blood pressure was stabilized after blood transfusion, fluid replacement and antibiotic treatment. But his hemoglobin level did not improved sufficiently on blood sampling. Bladder hemorrhage was considered to be prolonged. A cystography showed a rupture point at the apex of the bladder, and it was determined that surgical treatment was necessary. On the third day of admission, a partial resection of the perforated bladder wall was performed. Postoperatively, hematuria was improved, and the patient was well recovered with no progression of anemia. Spontaneous bladder rupture is a rare disease, and its accurate diagnosis is difficult to make because the clinical symptoms vary. It is important to perform cystourethrography promptly to make a correct diagnosis and to proceed to surgical treatment at the appropriate time.