Spontaneous rupture of the urinary bladder misdiagnosed as gastrointestinal perforation: a diagnostic pitfall in post-radiation patients

Bladder rupture is a rare but potentially life-threatening condition that can mimic gastrointestinal perforation, particularly when intra-abdominal free air is present. The case of an 82-year-old woman with a history of pelvic radiotherapy for cervical cancer that developed intra-abdominal free air after urinary catheterization is reported. The patient exhibited only mild abdominal tenderness, and computed tomography showed intra-abdominal free air. Emergency laparotomy was performed based on the radiological findings, showing intraperitoneal bladder rupture with the catheter extruded through the bladder wall. Retrospective analysis suggested that the combination of radiation-induced bladder wall fragility and mechanical irritation by the catheter contributed to the rupture. Clinicians should recognize that intra-abdominal free air is not always indicative of gastrointestinal perforation. Bladder rupture should be considered, particularly following radiation therapy in lower abdominal cancer patients. Detailed history taking and physical examination can help prevent misdiagnosis and unnecessary surgical intervention in cases with mild abdominal symptoms.