On examination, his abdomen was distended, firm, minimally tender, and without guarding. Workup revealed a white blood cell count of 5.8 THO/μL, hemoglobin level of 8.8 g/dL, creatinine level of 5.2 mg/dL, potassium level of 7.1 mmol/L, and glucose BMS354825 level of 1107 mg/dL. He was started on an insulin drip to control his glucose levels. A computed tomography (CT) scan of the abdomen and pelvis revealed a “bladder mass extending beyond the bladder wall and

involving the peritoneum diffusely and a severely distended stomach with air and fluid” (Fig. 1). A nasogastric tube was placed for bowel decompression, and a urinary catheter was placed with gross hematuria output. The patient was believed to be obstructed secondary to a large pelvic mass, and on hospital day 3, after he was stabilized and his glucose levels were controlled, he was transferred to our hospital for further care. On arrival to our institution, his abdomen was soft Pexidartinib but distended and minimally tender without guarding. After review of his history, examination, and films, there were concerns for bladder perforation and hemoperitoneum. A cystogram with 150-mL Isovue contrast revealed a bladder perforation with no significant filling defect to account for the bladder mass that had been read on the CT scan (Fig. 2). A cystoscopy confirmed

the presence of the bladder perforation and the absence of a bladder mass. A magnetic resonance imaging scan of the abdomen and pelvis confirmed the absence Thiamine-diphosphate kinase of an extravesical pelvic mass. The patient was subsequently taken for an exploratory laparotomy. Immediately on entering his peritoneal cavity, significant amount of blood and blood clots were encountered and removed.

Dissection down to the bladder was carried out, and in the absence of adhesions and pelvic mass, we easily found the through and through bladder perforation site located at the posterior aspect of the dome of the bladder. It was approximately 1 cm in diameter. The bladder was examined without any intravesical abnormalities visualized. Edges of the perforation site were excised to rule out tumor, and the bladder was closed in a standard 2-layer fashion. The bowels were examined in their entirety and appeared within normal limits. The abdomen was completely inspected and palpated, and there was no evidence of a mass or metastatic disease. Postoperatively, our patient’s symptoms improved significantly. Pathology from the bladder perforation edges was benign with no tumor seen. Follow-up voiding cystourethrogram on postoperative day 14 revealed a well-healed bladder, and his Foley catheter was removed. He was discharged on insulin after his HgbA1c was found to be 9.0 DCCT%. SBP is an extremely rare and potentially fatal urologic emergency. Most cases reported in the literature included an underlying etiology responsible for the rupture.1 In contrast, our patient lacked any risk factors.