Bladder Rupture: Causes, Symptoms, and Emergency Management

Bladder rupture is a rare but life-threatening urological emergency involving a full-thickness tear of the bladder wall. Prompt diagnosis and surgical repair are essential.

Etiology

1. Blunt trauma (most common): Motor vehicle crashes, falls, direct blows—especially with a full bladder.
2. Iatrogenic: Catheterization trauma, cystoscopy, pelvic surgery, radiation therapy (radiation cystitis).
3. Obstruction/overdistension: Benign prostatic hyperplasia (BPH), urethral stricture, tumors, fecal impaction, neurogenic bladder.
4. Pathological: Bladder cancer, severe infection, connective tissue disorders.
5. Spontaneous: Rare; associated with bladder wall weakening (e.g., post-radiation, malignancy).

Presentation

• Sudden, severe suprapubic/lower abdominal pain
• Gross hematuria (blood in urine) – present in ~80%
• Inability to void or oliguria
• Signs of peritonitis (rigidity, guarding) if intraperitoneal rupture
• Referred shoulder pain (Kehr's sign) if blood irritates diaphragm

Diagnosis

• CT cystogram (gold standard): Contrast instilled via catheter; extravasation confirms rupture.
• Ultrasound/FAST exam: Free fluid in pelvis; less sensitive for rupture itself.
• Retrograde cystogram: Alternative if CT unavailable.

Management

• Intraperitoneal rupture: Exploratory laparotomy with two-layer bladder closure; suprapubic catheter drainage.
• Extraperitoneal rupture: Often managed with prolonged catheter drainage (10–14 days) alone; surgery if complex or failed conservative care.
• Broad-spectrum antibiotics, analgesia, monitor for sepsis/electrolyte imbalance.

Outcomes are excellent with timely intervention. Delayed diagnosis risks sepsis, abscess, and chronic fistula.