Lessons to be learned: a case study approach 'Spontaneous' intraperitoneal bladder rupture in a psychiatric patient - with diagnostic difficulties

Abstract

The case described here is that of a 34-year-old woman with a psychiatric disorder who was referred to the local surgical receiving unit with abdominal pain and vomiting. She remained well and fully mobile but refused blood inves tigations until the day following admission. At that time the tests showed a picture of ac renal failure. With the development of increas ing abdominal tenderness and pyrexia she was persuaded to have a laparotomy which demon strated a small tear at the dome of the bladder.

Her deranged blood biochemistry returned to normal within 11 h following surgery. The important points demonstrated in this case study are the special clinical difficulties encountered in psychiatric patients, which may consequently lead to delay in diagnosis. This delay allowed significant peritoneal reabsorp tion of urea and creatinine, which masquerad ed as 'acute renal failure' on biochemical test ing. The case also highlights the use of procy clidine, commonly used in patients with psy chiatric disorders; urinary retention is a recog nised side effect of this drug - and it is possi ble that such retention together with a minor and hence easily overlooked episode of trau ma, may have contributed to the patient's con dition.