Korean J Urol.  2010 Apr;51(4):287-290.

Spontaneous Intraperitoneal Bladder Perforation Associated with Urothelial Carcinoma with Divergent Histologic Differentiation, Diagnosed by CT Cystography

Affiliations
  • 1Department of Urology, Kyung Hee University Graduate School of Medicine, Seoul, Korea. chlee@khu.ac.kr

Abstract

Spontaneous bladder perforation is a very rare event. Prompt diagnosis of this injury is very important, particularly with intraperitoneal perforation, because mortality increases if surgical repair is delayed. Previous studies have reported that plain cystography is the primary modality of imaging study rather than relatively insensitive computed tomography (CT) when bladder perforation is suspected. We report here a rare case of spontaneous intraperitoneal perforation of the bladder associated with urothelial carcinoma with divergent histologic differentiation, as diagnosed with CT cystography.

Keyword

Diagnosis, differential; Rupture, spontaneous; Urinary bladder neoplasms

MeSH Terms

Diagnosis, Differential
Rupture, Spontaneous
Urinary Bladder
Urinary Bladder Neoplasms

Figure

  • FIG. 1 Tumor tissue showing exophytic papillary growth and endophytic growth of moderately differentiated transitional cells with scattered bizarre hyperchromatic and pleomorphic nuclei (H&E, ×400).

  • FIG. 2 Urothelial carcinoma showing squamous differentiation with typical keratin pearl formation (H&E, ×400).

  • FIG. 3 (A) Contrast media extravasation was not observed between the bladder and the abdominal cavity in the plain film cystography. (B) In the post drain cystography, there was no evidence of bladder perforation.

  • FIG. 4 Contrast media extravasation and bowel loop pooling was observed on the CT cystography taken with the patient in the prone position with undiluted contrast media.


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