Open AccessAscitic fluid with ammonia odor as a symptom of bladder rupture
Author(s) -
Mizumura Naoto,
Imagawa Atsuo,
Kawasaki Masayasu,
Okumura Satoshi,
Toyoda Sho,
Ogawa Masao
Publication year - 2016
Publication title -
acute medicine and surgery
Language(s) - English
Resource type - Journals
ISSN - 2052-8817
DOI - 10.1002/ams2.150
Subject(s) - medicine , ascites , abdominal pain , cystography , radiology , abdominal fluid , percutaneous , surgery , urinary system
Case An 88‐year‐old woman presented with abdominal pain, massive ascites, and acute kidney injury. She was clinically hypervolemic and the computed tomography attenuation value of the ascites was near that of water. Subsequent abdominocentesis revealed ammonia‐smelling ascites fluid, leading to a suspicion of urinary tract injury, and a conclusive diagnosis of spontaneous bladder rupture was achieved using cystography. Outcome The patient was managed conservatively with antibiotics, percutaneous drainage, and bladder catheter. As a result, she was discharged with normal renal function. Conclusion The diagnosis of bladder rupture is difficult, and is rarely confirmed in the absence of a diagnostic suspicion. This case indicates that ascitic fluid odor, patient volume status, and the computed tomography attenuation value of ascites are potential indicators of bladder rupture.