Presentation
Presented 10 days post C-section with increasing abdominal distension and falling urine output. Clinical exam was generally unremarkable: no abdominal tenderness, with a non-inflamed wound. Vitals were normal. Normal hemoglobin with abnormal renal blood tests. Abdo USS: large volume ascites (images not available).
Patient Data
Intraperitoneal extravastion of contrast at the superior surface of the bladder with contrast-fluid level in the right and left paracolic gutters. Also a small intraperitoneal gas bubble is noted anterior to the bladder likely introduced through the Foley catheter.
Case Discussion
Intraoperative urinary bladder injuries are usually identified during surgery and are repaired immediately. If an injury is suspected injection of methylene blue dye through a catheter or cystoscopy can help identify the site of leak. In cases presenting later, fistulas may occur, or as in this case presenting with uroperitoneum and pseudorenal failure as a result of reverse autodialysis.