Spontaneous intraperitoneal rupture of the bladder.

Although uncommon, the so-called spontaneous or idiopathic rupture of the bladder is not rare; 84 cases have so far been reported. A common denominator in almost all these cases is that the rupture is intraperitoneal and that it is often unsuspected, the actual diagnosis being made at autopsy, after surgical exploration or, as in our case, retrospectively. We are proposing that bladder infarction may be the common denominator for all the contributary etiological factors, which include the following: long-term indwelling catheter, alcohol, medication such as bethanechol or methamphetamine, and weakening of the bladder wall as from a neuropathic bladder, a pseudodiverticulum, a chronic infection or a combination of these factors. The symptoms of intraperitoneal rupture of the bladder consist of the triad: pain, difficulty or inability to void and rigidity of the abdominal wall. Elevation of the blood urea seems to be a sensitive indicator of intraperitoneal bladder rupture. The most valuable diagnostic tool remains cystography. Early diagnosis requires a high degree of clinical suspicion and an increased awareness by the surgeon of the possibility of intraperitoneal bladder rupture.