Iatrogenic bladder injury following laparoscopic management of ruptured ectopic pregnancy: a case report and review of literature

Background: Iatrogenic bladder injury is an uncommon but recognized complication of gynecologic laparoscopy, most often occurring during trocar placement or pelvic dissection. While the majority of injuries are identified intraoperatively, missed injuries may present postoperatively with nonspecific findings such as abdominal distension, oliguria, and elevated serum creatinine due to intraperitoneal urinary leakage. Reabsorption of urinary solutes across the peritoneum can result in pseudo-acute kidney injury (pseudo-AKI), a reversible condition that mimics intrinsic renal dysfunction and may delay appropriate diagnosis. Case presentation: A 29-year-old woman underwent laparoscopic right salpingectomy for a ruptured ectopic pregnancy with hemoperitoneum. Although the initial procedure was uncomplicated, she developed progressive abdominal distension, inability to void, leukocytosis, and a rapid rise in serum creatinine on postoperative day 2. Abdominal imaging demonstrated intraperitoneal bladder rupture with urinary ascites. The patient subsequently underwent laparoscopic bladder repair with placement of a drain and a Foley catheter, resulting in rapid normalization of renal function and clinical improvement. Discussion: This case demonstrates how a ruptured ectopic pregnancy with hemoperitoneum may create a high-risk operative environment for unrecognized bladder injury due to distorted pelvic anatomy and limited visualization. It further highlights pseudo-AKI as an important diagnostic consideration in patients presenting postoperatively with abdominal distension, oliguria, and elevated serum creatinine following gynecologic laparoscopy. Conclusion: Early recognition of urinary tract injury and prompt imaging are critical in patients with unexplained postoperative abdominal distension and rising creatinine following gynecologic laparoscopy. Awareness of pseudo-AKI and timely minimally invasive repair can lead to rapid clinical recovery and favorable outcomes.