Spontaneous rupture of the urinary bladder (SRUB) is a rare urologic emergency. Among other predisposing factors, alcohol intoxication is well-documented due to its diuretic effect and the suppression of voiding reflexes. Intraperitoneal ruptures are more frequently encountered in SRUB, often presenting with nonspecific signs of acute abdomen, which frequently lead to delayed diagnosis and increased morbidity. Herein, we report a case of SRUB successfully managed with laparoscopic repair.

A 52-year-old female presented to the emergency department with lower abdominal pain, gross hematuria, dysuria, fever, and chills. She had a history of previous uterine myomectomy. She denied any recent trauma or catheterization but admitted to consuming a significant quantity of alcohol the night before symptom onset. Physical examination revealed suprapubic tenderness and abdominal guarding. Ultrasonography revealed ascites in cul-de-sac and liver recess. CT showed a focal defect at the dome of the urinary bladder with intraperitoneal contrast extravasation and associated hemoperitoneum.

The patient underwent emergency laparoscopic repair. Approximately 1500 mL of bloody ascites were evacuated. The bladder defect, measured about 5 cm at the dome, was trimmed and repaired in two layers—mucosal and seromuscular—by 4-0 Vicryl and 3-0 V-loc sutures respectively, to achieved a water-tight closure. On postoperative day 5, cystography revealed no contrast leakage, the Foley catheter was removed, and the patient was discharged uneventfully.

SRUB should be considered in patients presenting with acute abdomen and hematuria, especially in the context of alcohol intoxication or urinary retention. CT with contrast in delayed phase is key to prompt diagnosis. Laparoscopic repair is a feasible minimally invasive treatment option. This case reinforces the need for heightened clinical suspicion and timely surgical intervention to prevent severe complications associated with delayed treatment of SRUB.