Spontaneous bladder trauma after postpartum amniotic fluid embolism

A woman in her late 30s underwent a cesarean delivery for twin pregnancy with breech presentation. On postoperative day 4, she presented a sudden onset of inhospital cardiac arrest with the diagnosis of massive bilateral pulmonary embolism, suspicious of amniotic fluid embolism related. After multiple resuscitations including extracorporeal membrane oxygenation, the patient later developed abdominal distention and persistent hematuria on postoperative day. Abdomen computed tomography revealed a large extraperitoneal hematoma anterior to the bladder. One month later, bladder rupture was confirmed via cystoscopy. Initial conservative management with urinary drainage failed. Eventually, an open surgical repair was performed 4 months later, revealing rupture from the anterior wall to the dome of the bladder with surrounding necrotic tissue. This is a rare and complex case involving pulmonary embolism and spontaneous bladder perforation, requiring a multidisciplinary approach and eventual surgical diversion.