key: cord-1032845-loorusqm
authors: Marcos da Silva Barroso, Francisco; Dorgam Maués, Carolina Augusta; Lopes de Castro, Gustavo; Arthur da Cunha Alves, Roger; Carmo de Vasconcelos, Enny Luana; Guedes Saint Clair, José Paulo
title: Surgical management of spontaneous post-partum bladder rupture in an Amazonian emergency hospital
date: 2020-08-24
journal: Urol Case Rep
DOI: 10.1016/j.eucr.2020.101376
sha: 026042c23bb6fabfb862e4f64c2883e5b0f07648
doc_id: 1032845
cord_uid: loorusqm

Spontaneous rupture of the urinary bladder (SRUB) is a rare urological emergency and even more uncommon in the puerperium. Post-partum bladder rupture might be associated with fetal pressure on the not emptied bladder wall during labor. We report a case of SRUB three days after normal vaginal delivery with high values of creatinine and absence of hematuria, surgically managed in an emergency hospital in the Amazon.

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A 30-year-old woman (G2P2) was admitted to the emergency department with 1 ). The CT also revealed bilateral pleural effusion, probably caused by the inflammatory response (Fig. 2) . A CT cystography was not performed due to the absence of hematuria. The initial diagnosis was acute abdomen and the patient was booked for surgery. In labor, it is cautious to empty the bladder during the second stage to avoid its rupture. Post-partum patients who have had episiotomy or perineal repair frequently experience voiding difficulties which may lead to urinary retention 5 . Both situations may be related with spontaneous rupture of the urinary bladder.

In our case, the patient reported a small perineal laceration during labor repaired with six stitches suture. She also reported no emptying of the bladder or urethral catheterization after labor. Our patient presented at the emergency with acute abdomen and compromised renal function, which is the usual presentation in spontaneous bladder rupture.

Rupture of bladder in puerperium without predisposing factors is a post-partum emergency 2 . In this case report, the challenging diagnosis of intraperitoneal bladder rupture was made during laparotomy, consistent with most of the cases reported in the literature.

The patient follow-up is difficult, but it is essential to recommend to seek medical care in case of SRUB symptoms and also further specialized investigation with a urologist.

SRUB should be considered a differential diagnosis for acute abdomen in patients with elevated urea and creatinine values and a similar clinical feature. Post-partum rupture of the bladder requires a deeper review and the diagnosis of this urological emergency should not be delayed.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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