title: Spontaneous puerperal extraperitoneal bladder wall rupture in young woman with diagnostic dilemma.
abstract: A young female presented with an acute abdominal pain and oliguria for 1 week following normal vaginal delivery. No history of hematuria was present. Patient was having lochia rubra. Sealed uterine rupture was suspected clinically. Initial ultrasound of the patient showed distended urinary bladder containing Foley catheter ballon with clamping of Foley catheter and particulate ascites. Abdominal paracentesis revealed hemorrhagic fluid. Contrast-enhanced computed tomography of abdomen revealed ascites, distended urinary bladder and no extraluminal contrast extravasation in delayed scan. As patient condition deteriorated, repeat ultrasound guided abdominal paracentesis was done which revealed transudative peritoneal collection with distended bladder. Cystoscopy revealed urinary bladder ruptures with exudate sealing the rupture site. Exploratory laparotomy was done and a diagnosis of extraperitoneal bladder rupture was confirmed. The rent was repaired in layers. She was put on continuous bladder drainage for 3 weeks followed by bladder training. It presented in a unique way as there was hemorrhagic peritoneal tap, no macroscopic hematuria and urinary bladder was distended in spite of urinary bladder wall rupture which delayed the diagnosis and treatment. Complete emptying of urinary bladder before second stage of labor and during postpartum period with perineal repair is mandatory to prevent urinary bladder rupture.
authors.affiliation: Department of Urology, Institute of Medical Science, SUM Hospital, Ghatikia, Bhubaneswar, Odisha, India.
authors.forename: Debabrat Kumar
authors.initials: DK
authors.lastname: Sabat
authors.affiliation: Department of Obstretics and Gynecology, Institute of Medical Science, SUM Hospital, Ghatikia, Bhubaneswar, Odisha, India.
authors.forename: Pradeep Kumar
authors.initials: PK
authors.lastname: Panigrahi
authors.affiliation: Department of Radiology, Institute of Medical Science, SUM Hospital, Ghatikia, Bhubaneswar, Odisha, India.
authors.forename: Ranjan Kumar
authors.initials: RK
authors.lastname: Sahoo
authors.affiliation: Department of Obstretics and Gynecology, Institute of Medical Science, SUM Hospital, Ghatikia, Bhubaneswar, Odisha, India.
authors.forename: Mousumi
authors.initials: M
authors.lastname: Acharya
authors.affiliation: Department of Central Research Laboratory, Institute of Medical Science, SUM Hospital, Ghatikia, Bhubaneswar, Odisha, India.
authors.forename: Mahesh Ch
authors.initials: MCh
authors.lastname: Sahu
keywords: Extraperitoneal space; puerperium; rupture; urinary bladder