Ruptured urinary bladder after a ‘simple’ fall without pelvi
The present case has been published in the American Journal of Medicine.

A 99-year-old man was admitted after being found on the floor, confused and complaining of diffuse abdominal pain and difficulty voiding. His past medical history included obesity, diabetes, hypertension, and benign prostatic hyperplasia.

Examination revealed a stuporous patient, abdominal distention, and diffuse abdominal tenderness. Bladder catheterization yielded 600 mL of bloody urine. Laboratory tests revealed serum creatinine 13.7 mg/dL, blood urea nitrogen 96 mg/dL, sodium 123 mEq/L, potassium 7.8 mEq/L, phosphorus 12.2 mEq/L, calcium 8.7 mEq/L, and pH 7.15. Serum proteins, muscle and liver enzymes, and blood counts were normal. Cultures were negative.

X-ray studies and head computed tomography (CT) were unremarkable. Abdominal CT revealed some free fluid. Hyperkalemia was treated. Catheter irrigation with 400 mL normal saline yielded back only 200 mL. CT cystography with retrograde contrast demonstrated intraperitoneal extravasation. He was successfully operated on and made a slow recovery, and was discharged with creatinine 1.2 mg/dL.

Key takeaways:-
- Patient had perforated his urinary bladder after a low, “simple” same-level fall, without pelvic fracture—an extremely rare occurrence.

- Physicians evaluating elderly patients who have sustained a “minor” fall should be aware of the potential for occult serious internal organ injuries, including rarely reported rupture of the urinary bladder without pelvic fracture.

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