Although spontaneous rupture of the bladder due to subcutaneous nodules is relatively rare, it ranks first among cases of spontaneous bladder rupture. According to 80 cases of spontaneous bladder rupture documented in European and American literature, those occurring in the bladder subcutaneous nodules were the most common, accounting for 10 cases or 12.5%. Among the 18 cases of spontaneous bladder rupture reported domestically, 11 were caused by bladder subcutaneous nodules. In our hospital, from 1970 to 1975, 4 out of 5 cases of spontaneous bladder rupture were due to subcutaneous nodules. Therefore, this condition warrants clinical attention. The majority of patients affected by this disease are between 15 and 25 years of age. In terms of gender, foreign data show no significant difference, but domestic reports indicate that all 15 cases of spontaneous bladder rupture due to subcutaneous nodules were female.

bubble_chart Etiology

The spontaneous rupture of a bladder subcutaneous node primarily occurs because the lesion often involves the entire thickness of the bladder wall. If there is obstruction of the lower urinary tract or a sudden increase in intra-abdominal pressure, rupture can occur. Spontaneous rupture of a subcutaneous node bladder is almost always of the intraperitoneal type. The rupture site is mostly at the dome or posterior wall of the bladder. According to foreign data, out of 7 cases, 6 were located at the dome and 1 at the base. Among 15 cases reported domestically, 10 were at the dome, 4 at the posterior wall, and only 1 at the base. This may be related to the lack of surrounding tissue support in these areas, making them the weakest points during bladder distension. The size of the rupture varies from needle-sized to as large as a cup's mouth.

This disease is characterized by acute onset, critical and complex conditions, and is often misdiagnosed as other acute abdominal conditions. In cases of sudden abdominal pain without trauma, no history of urination after onset or only passing a small amount of hematuria, and the presence of peritoneal irritation signs, this disease should be considered, and a history of urinary subcutaneous nodes should be inquired. During physical examination, peritoneal irritation signs may be observed, but the severity is usually mild, often more pronounced in the lower abdomen, and bowel sounds typically do not disappear. These characteristics may be related to the bladder being a pelvic organ; its rupture causes urinary peritonitis, which irritates the peritoneum and intestines less severely than general purulent peritonitis, and the affected area spreads from the lower to the upper abdomen. Since urine continuously flows into the abdominal cavity after bladder subcutaneous node rupture, ascites signs are often positive. Abdominal paracentesis usually yields a significant amount of yellow fluid. Diagnostic catheterization often fails to produce urine or yields only a small amount of bloody urine. During bladder irrigation tests, the amount of fluid withdrawn is significantly less than the amount injected, but if the catheter enters the abdominal cavity, the amount withdrawn increases significantly. Bladder radiography may be used for confirmation if necessary. If the diagnosis remains uncertain, exploratory laparotomy should be performed promptly to avoid delaying critical treatment.

Spontaneous rupture of a subcutaneous node bladder is a severe complication of advanced-stage renal subcutaneous nodes. To further clarify upper urinary tract lesions, upper urinary tract examination is essential. Since advanced-stage renal subcutaneous nodes often present many challenges during urography, if the patient's condition permits, emergency surgical exploration of the bladder lesions should include examination of both kidneys and an indigo carmine test. This is of significant reference value for both disease etiology diagnosis and subsequent treatment.

The timing of surgical treatment for patients with spontaneous rupture of the bladder due to subcutaneous node is crucial for prognosis. Therefore, surgery should be performed as soon as possible after shock is corrected to repair the bladder perforation and perform a cystostomy. Postoperatively, systemic anti-subcutaneous node therapy should be administered. Further treatment should then be based on the condition of the renal subcutaneous node.