Kosin Med J.  2012 Dec;27(2):161-165. 10.7180/kmj.2012.27.2.161.

A Case of Spontaneous Bladder Rupture Mimicking Diabetic Nephropathy in a Patient with Type 2 Diabetes Mellitus

• Yang HK
• Kim NY
• Yeom SJ
• Kim JH
• Lee JM
• Chang SA

• KMID: 2308525
• DOI: http://doi.org/10.7180/kmj.2012.27.2.161

Abstract

Spontaneous rupture of the urinary bladder is a rare clinical entity, with the incidence reported as 1 in 126,000 hospital admissions. It is often associated with malignancy, inflammatory lesions, irradiation, calculus, diverticulum, binge alcohol drinking, continuous bladder irrigation, and neurogenic bladder. In rare instances, bladder rupture occurs without obvious causes. This rare clinical condition is difficult to diagnose because of vague symptoms. High index of suspicion is needed as the mortality rate is high if untreated. A 37-year-old woman with uncontrolled type 2 diabetes, was admitted to the emergency room complaining of progressive abdominal distension and discomfort. She had a past history of tubo-ovarian and bladder abscess, and had undergone multiple surgical operations. From ascites fluid study, she was diagnosed as spontaneous bladder rupture. A transurethral catheter was inserted and the symptoms and signs resolved. Bladder rupture, mimicking acute kidney injury of diabetic nephropathy was disclosed without surgery.

Keyword

Spontaneous rupture; Type 2 diabetes mellitus; Urinary bladder

MeSH Terms

Abscess
Acute Kidney Injury
Alcohol Drinking
Ascites
Calculi
Catheters
Diabetes Mellitus, Type 2
Diabetic Nephropathies
Diverticulum
Emergencies
Female
Humans
Incidence
Rupture
Rupture, Spontaneous
Urinary Bladder
Urinary Bladder, Neurogenic

Figure

• 

  Fig. 1 (A-D) A abdominal computed tomography (CT) shows a large amount of ascites and focal ventral hernia of the small bowel loop, without hydronephrosis. The right and left kidney sizes are within normal limits, measuring 10.8 cm and 10.5 cm, respectively.

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  Fig. 2 Clinical course of the present case. The serum creatinine levels showed a dramatic decrease after transurethral catheter insertion.

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  Fig. 3 Follow up CT urography. (A) Ascites was resolved. (B) Focal ventral hernia of the small bowel loop is still noted. (C, D) Diverticulum-like outpouching was noted in the dome portion of the bladder without contrast leakage from the bladder.

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