title: Acute abdomen caused by bladder rupture attributable to neurogenic bladder dysfunction following a stroke: a case report.
abstract: BACKGROUND
  Spontaneous bladder rupture is a rare and serious event with high mortality. It is not often considered in the patient presenting with peritonitis. This often leads to delays in diagnosis. There are very few case reports of true spontaneous rupture in the literature. This is the first such reported case in which bladder rupture was attributable to neurogenic bladder dysfunction following a stroke.
  
  
  METHODS
  We report the case of a 67-year-old Caucasian man who presented with lower abdominal pain and a peritonitic abdomen. He had a long-term urethral catheter because of urinary retention following a previous stroke. He was treated conservatively with antibiotics before a surgical opinion was sought. Exploratory laparotomy confirmed the diagnosis of spontaneous bladder rupture. After repair of the defect, he eventually made a full recovery.
  
  
  CONCLUSIONS
  In this unusual case report, we describe an example of a serious event in which delays in diagnosis may lead to increased morbidity and mortality. To date, no unifying theory explaining why rupture occurs has been postulated. We conducted a thorough literature search to examine the etiological factors in other published cases. These etiological factors either increase intra-vesical pressure or decrease the strength of the bladder wall. We hope that by increasing awareness of these etiological factors, spontaneous bladder rupture may be diagnosed earlier and appropriate therapy started.
authors.affiliation: Department of Urology, Cheltenham General Hospital, Sandford Road, Cheltenham, Gloucestershire, GL53 7AN, UK. thomas.mitchell@glos.nhs.uk.
authors.forename: Tom
authors.initials: T
authors.lastname: Mitchell
authors.forename: Samih
authors.initials: S
authors.lastname: Al-Hayek
authors.forename: Biral
authors.initials: B
authors.lastname: Patel
authors.forename: Fiona
authors.initials: F
authors.lastname: Court
authors.forename: Hugh
authors.initials: H
authors.lastname: Gilbert