Conservatively managed spontaneous intraperitoneal bladder perforation in a patient with chronic bladder outflow obstruction

We present the unusual case of a spontaneous intraperitoneal bladder rupture as a first presentation of chronic bladder outflow obstruction secondary to benign prostatic hyperplasia. A contributing factor to diagnostic delay was unfamiliarity with the classical presentation of abdominal pain, abdominal distension and urinary ascites leading to autodialysis represented by an unusually high serum creatinine. A cystogram was performed after a non-contrast computed tomography (CT) scan originally performed to determine the cause of abdominal pain, failed to confirm the diagnosis. The patient's initial acute presentation was successfully managed conservatively with prolonged urinary catheterization.