Bladder rupture post renal biopsy

Case contributed by Dr Dayu Gai

Presentation

This 62 year old female had a renal biopsy performed for investigation of glomerulonephritis. Three days after the biopsy, she described persistent haematuria. Post-biopsy trauma was suspected and a non contrast CT scan was performed of the kidney, ureter and bladder.

Patient Data

Age: 60
Gender: Female
Modality: CT
  • The findings suggest intra-peritoneal bladder rupture.
  • There is pneumoperitoneum. In addition, hyperdense material is seen in the right iliac fossa within an intraperitoneal location, suggesting haemoperitoneum. There is further free fluid within the peritoneal and retroperitoneal compartments. Hyperdense material is present within the bladder, which is decompressed. Metallic coils are seen in the lower left kidney with an adjacent wedge shaped hypodensity suggesting decreased perfusion.
  • A small amount of haematoma seen adjacent to the inferior pole of the left kidney.
  • There is a left femoral arterial line in situ.

Case Discussion

Bladder rupture can be categorised as either intra-peritoneal or extra-peritoneal1. Extra-peritoneal bladder rupture is more common, and is often associated with pelvic fractures. Intra-peritoneal bladder rupture is more uncommon and arises due to trauma when the bladder is already maximally distended. The patient demonstrated intra-peritoneal bladder rupture.

Intraperitoneal rupture of the bladder usually occurs at the dome. This is because the bladder dome  is the least supported of the bladder walls. Patients with intraperitoneal rupture may present with pseudo-renal failure3. This is due to the peritoneum absorbing creatinine and urea from the extravasated urine, causing serum tests to resemble that of renal failure.

Definitive management if bladder rupture is with operative bladder repair. This can either be open or laparoscopic. In one study, conservative management of a patient with bladder rupture failed, and ended up requiring extended open surgical repair of the defect2.

To our knowledge, there has only been one documented case of intra-peritoneal bladder rupture post renal biopsy. This was a 64 year old female who developed bladder rupture on Day 20 after a renal biopsy for possible lupus nephritis2. The authors suggested that the mechanism of rupture was due to formation and retention of bladder clot due from the renal biopsy, leading to increased intravesical pressures culminating in bladder rupture.

Case contributed by A/Prof. Pramit Phal.

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Case Information

rID: 30863
Case created: 7th Sep 2014
Last edited: 24th Nov 2015
System: Urogenital
Inclusion in quiz mode: Included

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