title: Spontaneous bladder rupture diagnosis based on urinary appearance of mesothelial cells: a case report.
abstract: BACKGROUND
  Spontaneous bladder rupture is an extremely rare clinical event that is associated with urinary ascites and apparent acute renal failure. This event is difficult to diagnose clinically, even with advanced techniques such as computed tomography; however, the timely diagnosis of this condition is critical. Here, we report a case of a patient who experienced a spontaneous intraperitoneal bladder rupture 10 years after postoperative pelvic irradiation for the treatment of uterine cancer. In this report of a rare case, we describe the contribution of the appearance of mesothelial cells in the urine to the diagnosis of this condition.
  
  
  METHODS
  Our patient was a 71-year-old Asian woman who experienced lower abdominal pain and vomiting of two days duration. On admission, abdominal computed tomography showed intraperitoneal fluid collection and her blood tests revealed acute renal failure and hyperkalemia. She underwent hemodialysis and a transurethral catheter was inserted. The transurethral catheter was removed three days after her admission. Four days after the catheter removal, her symptoms recurred and her serum creatinine and blood urea nitrogen levels were elevated. We noted the presence of mesothelial cells in her urine, which led to a diagnosis of intraperitoneal bladder rupture. She underwent surgical repair of her bladder and hyperbaric oxygen therapy, and was discharged after her renal function returned to normal.
  
  
  CONCLUSIONS
  Urine analysis is a simple and non-invasive test and we believe that a thorough urine analysis may contribute to the early diagnosis of an intraperitoneal bladder rupture. We think that the findings presented in this case report will significantly enhance our understanding of the etiology of bladder rupture. Moreover, these case findings may help nephrologists and urologists to rapidly diagnose this condition.
authors: Waka
authors: W
authors: Hayashi
authors: Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan. tnishino@nagasaki-u.ac.jp.
authors: Tomoya
authors: T
authors: Nishino
authors: Satoru
authors: S
authors: Namie
authors: Yoko
authors: Y
authors: Obata
authors: Masataka
authors: M
authors: Furukawa
authors: Shigeru
authors: S
authors: Kohno