Nasrini Tala, Traylor Blaine, Chow Nathan, Yang Shaun K, Chlopek Mitch F, Martini Wayne A
Internal Medicine, Mayo Clinic Arizona, Phoenix, USA.
Emergency Medicine, Mayo Clinic Arizona, Phoenix, USA.
Cureus. 2025 Jul 8;17(7):e87550. doi: 10.7759/cureus.87550. eCollection 2025 Jul.
A previously healthy 39-year-old man presented with progressive abdominal distension and discomfort one week after a high-velocity ground-level fall. He initially sought care elsewhere but was discharged without a definitive diagnosis. On presentation to our institution, he exhibited signs of acute kidney injury, abdominal compartment syndrome, and elevated intra-abdominal pressure. Point-of-care paracentesis revealed 7.9 L of fluid with markedly elevated creatinine, consistent with urinary ascites. A CT urogram confirmed bladder dome rupture. The patient underwent exploratory laparotomy with successful bladder wall and peritoneal repair. Postoperatively, he improved without the need for dialysis. This case illustrates an uncommon but critical diagnosis of intraperitoneal bladder rupture following blunt abdominal trauma, masquerading as acute kidney injury due to reverse autodialysis. Recognition of urinary ascites and early surgical intervention can prevent misdiagnosis and irreversible renal injury.
一名此前健康的39岁男性在高速地面坠落一周后出现进行性腹胀和不适。他最初在其他地方就医，但未明确诊断就出院了。到我们机构就诊时，他表现出急性肾损伤、腹腔间隔室综合征和腹内压升高的迹象。床旁腹腔穿刺抽出7.9升液体，肌酐明显升高，符合尿性腹水。CT尿路造影证实膀胱穹窿破裂。患者接受了剖腹探查术，成功修复了膀胱壁和腹膜。术后，他无需透析病情就得到了改善。该病例说明了钝性腹部创伤后罕见但关键的腹膜内膀胱破裂诊断，因逆向自身透析而伪装成急性肾损伤。认识到尿性腹水并早期进行手术干预可防止误诊和不可逆转的肾损伤。
