1172 Spontaneous Bladder Perforation: A Differential Never to Forget in the Acute Abdomen

Abstract

Abstract Introduction Spontaneous bladder perforation is a rare occurrence, and diagnosis is often one that is difficult to make. The morbidity and mortality of such patients can be high if not identified early and the appropriate management undertaken promptly. Here we present the case of a 60-year-old man who presented to hospital with recurrent episodes of spontaneous bladder perforation, how he was diagnosed, and how he was managed. Case Details A 60-year-old man presented to accident and emergency with peritonism, haemodynamic instability and fevers. He had a background of previous rectal cancer, managed with anterior resection and radiotherapy. Investigation with CT identified free fluid within the abdomen and pelvis, with no clear cause identifiable. Urine dipstick was positive for haematuria. The diagnosis was only confirmed using urethrogram. Management was conservative with bladder rest and urethral catheter. The patient represented two years later with similar symptoms, and diagnosis was again only made on urethrogram. Again, he was managed conservatively with bladder rest and catheterisation. Despite the healing of the bladder perforations, he has suffered from numerous complications including pyelonephritis and fistulation. Discussion It is important to learn from these rare cases of spontaneous bladder perforations, as the differential is one that should not be overlooked when assessing patients with an acute abdomen. Furthermore, despite management of the perforation, these patients can suffer from ongoing complications going forward.