Abstract

Most commonly, patients who present to the emergency department with a history and physical examination suggestive of urinary bladder rupture report a preceding traumatic event. Spontaneous atraumatic bladder rupture is relatively uncommon, but can occur in the context of a recent alcohol binge. The alcohol-intoxicated patient presents diagnostic and therapeutic challenges to the emergency physician (EP) that take on additional urgency given the high mortality of unrecognized bladder rupture. This case report reviews bladder anatomy, the unique physiological changes in the alcohol-intoxicated patient, and the high mortality rate of a ruptured urinary bladder. We review the historical diagnostic imaging options followed by a discussion of how bedside ultrasound could expedite diagnosis and management. We present the case of a patient with spontaneous atraumatic rupture of the urinary bladder after a recent alcohol binge. Bedside ultrasound was utilized by the EP to determine the need for emergent surgical consultation and intervention. We recommend that EPs consider bladder rupture in their initial evaluation of patients presenting with nonspecific abdominal pain in the context of recent alcohol intoxication. When using bedside ultrasound to evaluate the pelvis, the presence of anterior or posterior vesicular fluid collections, the loss of normal pelvic landmarks, or irregularities in the bladder wall may increase the EPs suspicion for this disease entity and expedite time-sensitive management.

Highlights

  • The alcohol-intoxicated patient presents diagnostic and therapeutic challenges to the emergency physician (EP)

  • Since high rates of mortality have been reported for cases of bladder rupture not recognized and managed early [1-3], bedside ultrasound may be useful in expediting the diagnosis and treatment of this surgical emergency

  • Case presentation An 18-year-old male presented to the emergency department (ED) with several episodes of vomiting bright red blood and abdominal pain

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Summary

Background

The alcohol-intoxicated patient presents diagnostic and therapeutic challenges to the emergency physician (EP). An 18 French nonweighted nasogastric tube was passed without difficulty, and gastric lavage revealed a small amount of blood clots before running clear aspirates that smelled of alcohol. At this time, the patient began to complain of increased lower abdominal distension and the inability to void. The urinary bladder was collapsed around a Foley catheter with high-density fluid within the bladder compatible with blood products (Figure 6). These findings were consistent with rupture of the urinary bladder. The recovery was unremarkable, and the patient was discharged on postoperative day 3

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