Bladder rupture, a relatively rare condition, is most commonly due to abdominal or pelvic trauma but may be spontaneous or iatrogenic in association with surgical or endoscopic procedures. The cardinal sign of injury to the bladder is gross hematuria. Clinicians can quickly diagnose and treat bladder injuries when typical clinical signs are present.

We presented a rare case of delayed intraperitoneal bladder rupture resulting from blunt trauma. In this case, because of the near-sepsis condition and hemodynamic instability, we use point-of-care ultrasound and abdominal paracentesis to confirm the diagnosis of bladder rupture. The patient was successfully treated with laparoscopic to suture the bladder rupture, along with medical management, including intravenous fluid, IV antibiotics, and symptomatic controls. She was discharged nine days after hospitalization.

A 43-year-old female, presented because of acute abdominal pain. 8 days ago, she was hit by a motorbike, resulting in a closed left tibial plateau fracture, which underwent bone fusion surgery. One hour before admission, the patient felt severe bladder retention and then heard a “poof” sound from her abdomen. A point-of-care ultrasound (POCUS) revealed large amounts of abdominal fluid and abdominal paracentesis showed a yellow-like urine fluid. The patient was diagnosed with generalized peritonitis due to a late bladder rupture and underwent laparoscopic surgery. Only eight cases reported in the current literature, which treatment delays varied from 3 to 28 days, with an average delay of about 11 days. With high sensitivity and specificity, conventional retrograde cystography and CT cystography are commonly used for clinical bladder injury detection. However, in an urgent case, POCUS can be used as an effective modality for assessing acute abdominal condition. We hypothesize that the bladder wall injury in our patient was initially a partial contusion that had progressed after urine retention into a full-thickness perforation (LaPlace law) on the eighth day after the accident.

Delayed bladder rupture should be investigated in patients with an acute distended abdomen and a recent history of blunt trauma. POCUS can be helpful in assessing this condition and determining the need for surgery, especially in cases with a near-shocked status.