The 77-year-old male patient with type 2 diabetes and hypertension for 10 years presented with complaints of abdominal pain, evident abdominal distention, mild breathlessness for seven hours with no convulsions, no concern of the flu or fever, and no coughing or expectoration. He had no prior history of trauma but had trouble urinating and defecating for four days. Additionally, he received antiviral, analgesic, and nutritional nerve therapy for sacral herpes zoster one week before admission.
During a physical examination, his abdomen was distended and tender. Especially in the hypogastric area, with guarding and rebound tenderness, and he had significant ascites. Herpes was already present in the sacral region, causing some skin damage. The results of a digital rectal exam showed an enlarged prostate without any palpable nodules.
A substantial quantity of effusion was seen in the abdomen and pelvis, along with a large number of contents in the colon and a suspected bladder breach, according to abdominal computer tomography. Blood analysis revealed hypoxemia and metabolic acidosis with hyperkalemia, whereas blood tests showed raised inflammatory markers. Potassium levels in the blood were 6.53 mmol/L, creatinine levels were 558 mmol/L, and D-dimer levels were 6.93 mg/L, according to blood biochemical tests. To stabilize the patient’s vital signs, lower potassium levels, and insert an indwelling catheter, the patient was admitted to the critical care unit. Leaving the catheter in place for three hours caused a steady flow of 3300 mL of bloody urine, which considerably reduced the patient’s abdominal distension.
After contemplating the diagnosis of intraperitoneal bladder rupture, surgeons chose to perform a laparotomy along with an abdominal CT. The surrounding intestinal canal was confirmed to be normal, but a 2 cm tear in the bladder wall that connected to the abdominal cavity was detected during the procedure. A urinary catheter was in place, and bladder repair and cystostomies were performed. Following the procedure, 2 g of cefoperazone sulbactam sodium was given every 8 hours.
On the first day, the patient vented and ate liquid meals. On day two, the patient’s creatinine level returned to normal. Moreover, on the third day, defecation was regained. On the thirteenth day, the urinary catheter was withdrawn. On the fourteenth day, the bladder fistula was removed. The patient’s spontaneous micturition was normal. The prostate was measured by B-ultrasound to be around 18.104.22.168 cm. There was no residual urine in the bladder, which could be easily retrieved and expelled, according to an ultrasonography
A very uncommon but potentially fatal urological emergency is spontaneous bladder rupture. The fatality rate is roughly 50%, and most deaths involve men. The most frequent causes of neurogenic bladder include malignant tumors, pelvic penetrating radiation therapy, persistent bladder inflammation or infection, bladder diverticulum, and obstruction of the bladder outlet. Weakening of the bladder wall and/or increased intravenous pressure are connected with susceptibility conditions.
In this instance, it appears that a herpes zoster infection in the sacral area and an increase in bladder pressure led to AUR, which in turn caused the bladder rupture. AUR may be explained by the virus infecting peripheral nerves, including the parasympathetic motor neurons, bladder, and skin in the sacral area (S2-S4), as well as sensory nerves that innervate those areas.
A previous physical examination revealed that the patient had a history of benign prostatic hyperplasia (BPH). He had never taken a 5-receptor blocker or a reductase inhibitor, and he exhibited no signs of a lower urinary tract obstruction. Prostatic hyperplasia was detected by B-ultrasound, although median lobe protrusion into the bladder was not detected by CT. As a result, it was concluded that BPH and AUR were not significantly correlated in this instance. This spontaneous bladder rupture is frequently confused with the mechanical lower urinary tract blockage brought on by BPH.