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Case 218


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Male 32 years old patient attends the emergency department with reports of vomiting , abdominal pain the ceasing of flatus and feces elimination for two days. He reports preserved diuresis. Physical examination : Dehydrated; distended abdomen with diffuse tenderness and voluntary defense , with no signs of peritonitis; rectal examination showcasing normal sized prostate. Assessment: blood count , liver function, amylase and lipase within the reference margins, creatinine : 6.71 mg / dL ; urea 70mg / dL. A chest X-ray was requested, showing no alteration, and abdominal radiography was performed (Image 1).

Considering the clinical history and images, which is the most likely diagnosis?

a) Urinary bladder rupture


b) Benign prostatic hyperplasia


c) Intestinal Obstruction


d) Acute pancreatitis


Image analysis

Image 1: Abdominal radiography in the supine position. Medially deviated ascending colon (yellow arrow), which may suggest the presence of abnormal intraperitoneal content.


Image 2: Retrograde cystography. Extravasation of contrast superiorly to the bladder (blue arrows) and to the right paracolic gutter (green arrow).


- Extraperitoneal rupture of the bladder is associated in most cases with pelvic bone fractures , due to a piercing mechanism by bone spicules;

- Intraperitoneal bladder rupture usually occurs in situations where the intravesical pressure rises suddenly, overcoming the resistance exerted by the bladder walls;

- Laboratory findings in intraperitoneal rupture can mimic those of a renal failure due to leakage of urine into the peritoneal cavity, with reverse dialysis of its solutes.

- Retrograde cystography has an accuracy of 85-100 % to identify bladder lesion.

- Symptoms are usually non-specific and are more often represented by the triad : gross hematuria , suprapubic pain or sensitivity and difficulty or inability to urinate.

- Treatment for intraperitoneal bladder rupture is surgery.


- Arun KG, Salahauddin, Leela V, Noel J, Venkatesh K, Ramakrishnan S, Dilip R. Intraperitoneal bladder rupture mimicking acute renal failure. Indian J Nephrol. 2008 Jan; 18(1): 26-27.

- Quagliano PV, Delair SM, Malhotra AK. Diagnosis of blunt bladder injury: a prospective comparative study of computed tomography cystography and conventional retrograde cystography. J of Trauma. 2006; 61(2): 410-21.

- Ziran BH, Chamberlin E, Shuler FD, Shah M. Delays and difficulties in the diagnosis of lower urologic injuries in the context of pelvic fractures. J of Trauma. 2005; 58(3): 533-537.

- Gill BC, Rackley RR, Vasavada SP. Bladder Trauma. Medscape 2015. [Acesso em setembro de 2015]. Disponível em:

- Gomes Carlos Augusto, Figueiredo André Avarese de, Soares Júnior Cleber, Bastos Netto José Murillo, Tassi Fabrício Rodrigues. Acute abdomen: spontaneous bladder rupture as an important differential diagnosis. Rev. Col. Bras. Cir.  [Internet]. 2009  Ago [citado  2015  Set  27] ;  36( 4 ): 364-365.

Available at:


Daniela de Souza Braga, 6th year medical student at UFMG.

E-mail: danibragamed[at]


Lucas José Resene, 4th year medical student at UFMG.

E-mail: lucasresende.ufmg[at]


Ricardo Mazilão Silva, , 4th year medical student at UFMG. 

E-mail: ricardodma789[at]


Dr. Luiz Carlos Teixeira, general surgeon at Hospital João XXIII

E-mail: dr.luizcarlosteixeira[at]


Fellype Borges, André Guimarães, Bárbara Queiroz, Pétala Silva and Prof. Viviane Parisotto.

Translated by

Rafael Fusaro Aguiar Oliveira, 5th year medical student at UFMG.

E-mail: rafusaro[at]





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