Spontaneous bladder rupture attributable to a radical hysterectomy-associated neurogenic bladder in patients with cervical cancer: a case report and literature review

Abstract

Introduction and importance: Spontaneous bladder rupture (SBR) is an extremely rare urological emergency. Herein we report a rare case of SBR in a postoperative cervical cancer patient, which was attributable to bladder distension due to a radical hysterectomy-associated neurogenic bladder. Case presentation: A 74-year-old nulliparous Japanese patient with cervical cancer (pT1b3N0M0) presented with acute abdominal pain nine days after a radical hysterectomy. The pretreatment workup included plain computed tomography (CT) revealed the presence of ascites in the absence of gastrointestinal perforation. The patient was initially diagnosed with generalized bacterial peritonitis and treated with antibiotics. Urine outflow was noted 5 days later from the vaginal stump. Subsequent contrast-enhanced CT demonstrated a bladder wall defect with presence of contrast medium in the abdominal cavity. The patient was diagnosed with SBR and was conservatively treated with antibiotics and prolonged catheterization (4 weeks); these measures showed no signs of therapeutic efficacy. The patient was subsequently treated surgically with an ileal conduit urinary diversion. The patient is currently free of disease. Clinical discussion: A literature review revealed that a history of pelvic radiotherapy is the main predisposing factor for SBR in women with cervical cancer. Our case serves to alert physicians that SBR should be considered a differential diagnosis in postoperative cervical cancer patients without a history of pelvic radiotherapy who experience generalized peritonitis symptoms or present as an acute abdomen. Conclusion: SBR can develop in cervical cancer patients without a history of radiotherapy. This differential diagnosis should be considered in patients with a radical hysterectomy-associated neurogenic bladder