TY  - EJOU
AU  - Mercedes, Raidizon 
AU  - Eidelman, Eric 
AU  - Mawhorter, Michael 
AU  - Yudovich, Max 
AU  - Aminsharifi, Alireza 

TI  - Spontaneous rupture of the urinary bladder after pelvic angioembolization: high clinical suspicious for prompt diagnosis is the key
T2  - Canadian Journal of Urology

PY  - 2025
VL  - 32
IS  - 5
SN  - 1488-5581

AB  -  <b>Background:</b> Spontaneous rupture of the urinary bladder (SRUB) is a rare condition characterized by bladder rupture without any trauma or previous instrumentation. Diagnosing SRUB can be challenging, leading to potential delays in treatment and significant morbidity. <b>Case description:</b> We present a case of a 75-year-old male with a complex medical history, including atrial fibrillation, systemic lupus erythematosus, antiphospholipid syndrome, and chronic anticoagulation, who developed sudden onset gross hematuria and abdominal pain following bilateral internal iliac artery angioembolization for a spontaneous pelvic hematoma in the setting of supratherapeutic anticoagulation. Extraperitoneal bladder perforation was confirmed by CT cystogram. Conservative management failed, and bladder exploration confirmed a friable, ischemic bladder wall defect. Bladder repair was performed with reinforcement using an absorbable fibrin sealant patch. Follow-up imaging demonstrated gradual resolution of urine extravasation, and the patient ultimately regained spontaneous voiding after catheter removal. <b>Conclusions:</b> This report underscores the importance of high clinical suspicion for SRUB in patients with pelvic ischemic insults, particularly after angioembolization. Although rarely reported in the literature, bladder rupture may represent a potential complication in this setting. Early imaging and surgical intervention are critical for favorable outcomes. Clinicians should consider ischemia-related SRUB in differential diagnoses to reduce diagnostic delays and optimize management strategies.
KW  - spontaneous rupture of the urinary bladder (SRUB); pelvic angioembolization; complications; bladder injury

DO  - 10.32604/cju.2025.067973