Analysis of peritoneal fluid in urinary ascites

Urinary Ascites: An Imitator of Portal Hypertension-Related Ascites

Urinary ascites is a rare and lesser-known etiology of ascites that may mimic portal hypertension (pHTN). We present an unusual case of urinary ascites in a patient with no apparent risk factors for bladder rupture. A 56-year-old woman with an uncomplicated, remote history of abdominal surgery presented with recurring episodes of ascites of unknown etiology. Of note, she has a history of functional, chronic urinary retention due to paruresis, a phobia of public urination. She had abdominal distension on the exam. Paracentesis revealed an elevated serum-ascites albumin gradient (SAAG), concerning portal hypertension. Additionally, the ascites creatinine to serum creatinine ratio was found to be extremely elevated at over 1, and a CT cystogram ultimately revealed bladder rupture, indicating a source of urinary leakage into the peritoneal space. This case report discusses the clinical recognition of urinary ascites as a mimic of apparent portal hypertension-related ascites and appropriate management.

Pseudo-acute kidney injury after minor trauma: A case report and review of literature

Acute kidney injury (AKI), a common diagnosis in the emergency department, is defined as a reduction in renal filtration function, with decrease in urine output, increase in serum creatinine, or both. However, a rise in serum creatinine can occur without AKI: the principal cause of a pseudo-AKI is urinary ascites, caused by urinary tract rupture, followed by reverse intraperitoneal dialysis and resorption of creatinine. The intraperitoneal leak of free urine is mainly traumatic, and half of the cases are iatrogenic. A case of intraperitoneal bladder rupture after minor trauma is presented with a review of the pathology of pseudo-AKI.

Pseudo-renal failure: bladder rupture with urinary ascites

We report a case of pseudo-renal failure caused by urinary ascites due to spontaneous bladder rupture following transurethral resection of a bladder tumour (TUR-BT). A 63-year-old man presented with 2 months of abdominal distension due to ascites. Laboratory findings showed elevated serum creatinine and hyperkalaemia. Peritoneal fluid urea, creatinine and potassium levels were greater than those in serum levels. CT scan showed partial wall thinning in the bladder wall, and cystography indicated fragility in the dome where the latest TUR-BT was performed. Pseudo-renal failure (laboratory abnormalities of acute kidney injury in the setting of normal kidney function) from urinary ascites and reverse intraperitoneal dialysis was diagnosed. Symptoms and laboratory abnormalities improved promptly with insertion of a urinary catheter. This report aims to increase recognition of urinary ascites when a patient with genitourinary surgical procedures or radiation therapy, or blunt abdominal trauma, presents with ascites and elevated creatinine simultaneously.

Neonatal urinary ascites: a report of three cases

Urinary ascites in neonates is not a common condition. Three cases of urinary ascites are presented and each of them has a different aetiology. Neonates with urinary ascites usually present as clinical emergency, requiring resuscitation, ventilator support, and subsequent drainage of urine. The ultimate management depends on the site of extravasation and the underlying cause.

Conservative treatment of an intraperitoneal bladder perforation

INTRODUCTION

The management of bladder rupture depends on its anatomical location.

MATERIAL AND METHODS

Case report and review of the pertinent English language literature.

RESULTS

A 56-year-old man with history of an anterior rectum resection with partial cystectomy presented with signs of acute renal failure, and later with a tender, distended abdomen. Work-up including serum and ascites biochemistry, cystoscopy, and CT cystography diagnosed urinary ascites. The small intraperitoneal bladder rupture was treated conservatively via continued urinary drainage under urinary antibiotic prophylaxis until closure.

CONCLUSION

A conservative treatment of a small intraperitoneal bladder perforation is possible under certain conditions.

Bladder injury mimicking acute renal failure after cesarean section: a diagnostic challenge and minimally invasive management

The reported incidence of bladder injury after cesarean section ranges from 0.14% to 0.94%. Most of the injuries were found intraoperatively. Delayed presentation is rare. We report a patient with bladder perforation presented with 'acute renal failure' and ascites 14 days after an uneventful cesarean section. Her clinical picture and initial presentation mimicked those of ureteric injury. Conventional cystography failed to demonstrate the bladder perforation. Computed tomography cystography clarified the diagnosis. Subsequent laparoscopic bladder repair resulted in quick and smooth recovery. This case highlights the pitfall of conventional cystography and the successful use of laparoscopy in management of this urologic condition. Literature was reviewed for this condition and its management.

Spontaneous bladder rupture caused by a giant vesical calculus

Spontaneous rupture of the urinary bladder is an uncommon occurrence. A 36-year-old man had complaints of pain and progressive distension of abdomen and anuria for 2 days. His abdomen was tense, tender and distended with free fluid. Blood urea was 340 mg% and ascitic fluid urea was 337 mg%. An USG showed massive ascitis, a large vesical calculus and a left renal calculus. The urinary bladder could not be catheterized. Patient underwent hemodialysis and placement of abdominal drains. About 2 l of yellow turbid fluid was drained. Cystolithotomy showed a 6 cm size impacted calculus with a rent in the dome of the bladder, which was repaired. Subsequently patient underwent percutaneous nephrolithotrypsy for left staghorn renal calculus and nephrectomy for right non-functioning kidney.

Diagnosis of postoperative urinary ascites using renal scintigraphy

Nuclear medicine biliary studies have been routinely used to identify bile leaks that occur after laparoscopic cholecystecomy. The use of a Tc-99m mercaptoacetyltriglycine (MAG3) renal scan to diagnose a case of urinary leakage that occurred after a laparoscopic-assisted colectomy is shown in this report. Laparoscopic surgery is widely used in place of conventional laparotomy to minimize recovery time and discomfort after surgery. The complication rate for laparoscopic colectomy has been reported as approximately 6% to 10%. In particular, ureteral leak has been reported in 2% of procedures. Ascites of unknown origin can become a diagnostic dilemma. We present a case of postoperative ascites of unknown origin that was successfully diagnosed as urinary leakage using renal scintigraphy.

Intraperitoneal bladder rupture after normal vaginal delivery

To our knowledge we report the first case of bladder perforation in a patient with no history of pelvic surgery or delivery. The patient presented 3 days post partum with renal failure and ascites. Paracentesis and cystography confirmed urinary ascites and bladder rupture. After open bladder repair convalescence was uneventful. The literature on intraperitoneal bladder rupture and urinary ascites is reviewed.

The hyponatremia of neonatal urinary ascites: clinical observations, experimental confirmation and proposed mechanism

A case of neonatal urinary ascites with severe hyponatremia is reported. Critical review of the literature on neonatal urinary ascites, which included determination of serum electrolytes, revealed a 70% incidence of hyponatremia. In an attempt to explain the mechanism of the hyponatremia, urinary ascites was produced in rats by creation of either a unilateral (uretero-peritoneal) or bilateral (vesicoperitoneal) shunt. Hyponatremia did not occur in the unilateral group but it was profound in the bilateral group. At 48 hours postoperatively renin was unchanged in the unilateral group but it was significantly elevated in the bilateral group. Aldosterone was elevated in the unilateral group and markedly elevated in the bilateral group. Urine entering the peritoneal cavity equilibrates with plasma. The proposed mechanism of hyponatremia in the bilateral group is autodialysis with intraperitoneal urine containing progressively lower sodium concentration secondary to increased renin and aldosterone.