Spontaneous Bladder Rupture Presenting as a Urinary Cutaneous Fistula During Chemotherapy in a Radiated Pelvis
Yuko Horiuchi, Tamaki Yahata, Naoyuki Iwahashi, Tomoko Noguchi, Kumiko Nakata, Kaho Nishioka, Megumi Fujino, Junya Hirayama, Mika Mizoguchi, Yasushi Mabuchi, Kazuhiko Ino
Spontaneous rupture of the urinary bladder is a rare event that may be caused by prior radiotherapy,
bladder dysfunction, alcoholic intoxication, cancer invasion, and inflammation. We herein describe a
58-year-old woman diagnosed with spontaneous bladder rupture presenting with a urinary-cutaneous
fistula during chemotherapy for peritoneal cancer. Twenty-five years ago, the patient underwent
radical hysterectomy followed by radiotherapy for cervical cancer and developed neurogenic bladder.
She was referred to our hospital due to pleural effusion and ascites. After exploratory laparotomy,
she was diagnosed with stage IVB peritoneal cancer. She received chemotherapy with paclitaxel and
carboplatin. While chemotherapy was effective, she was hospitalized for left pyelonephritis and septic
shock. After receiving antibiotics, she was recommended for self-catheterization for urination. After the
fifth course of chemotherapy, she presented with a large amount of fluid leaking from the lower part of
her abdominal wound. Computed Tomography (CT) and cystography suggested that extraperitoneal
rupture of the urinary bladder had led to an abscess of the space of Retzius, with urine and pus leaking
from the urinary-cutaneous fistula. A urinary balloon catheter was placed and the deep abscess cavity
was washed out. After 2.5 months, both the extraperitoneal bladder rupture and the fistula resolved
with conservative management. Two years after resuming chemotherapy, the patient died from the
progression of peritoneal cancer.
