Spontaneous rupture of urinary bladder in second trimester of pregnancy: A case report

摘要

The patient was a 35-year-old woman, presenting at 16th weeks gestation in her fourth pregnancy.Three days prior to her admission, she had presented with abdominal pain and voiding difficulty where she was treated for lower urinary tract infection. Later, the patient presented with acute onset of generalised abdominal pain.On examination, the abdomen was distended with guarding. Pelvic examination revealed a tender fullness in pouch of Douglas and the gravid uterus felt retroverted.A urethral catheter was inserted and 200 mL clear urine was drained. No obstruction to the passage of the catheter was noted. A provisional diagnosis of intraperitoneal haemorrhage was made.At laparotomy, the peritoneal cavity was found to contain large amount of clear yellow fluid (2.5 L). Surprisingly, a 2-cmrent was discovered at the apex of the urinary bladder.The bladder was repaired and its margins were trimmed and closed in two layers. An omental patch was mobilised to cover the repair, and a pelvic drain was inserted. Intravenous antibiotics were commenced for 48 h. An indwelling long-term Foley catheter (16F) was inserted for the remainder of the pregnancy.Urine cytology and culture were negative. Serum investigations showed elevated urea and creatinine that normalised the next day. Histopathological examination of the bladder wall demonstrated acute and chronic inflammation.The patient had an elective caesarean section at 38 weeks of gestation with bilateral tubal ligation, and a healthy boy weighing 3.3 kg was delivered. The urinary catheter was removed in 48 h, and the patient was discharged in good condition.