International Journal of Global Health

International Journal of Global Health

Current Issue Volume No: 1 Issue No: 3

Case-report Article Open Access
  • Available online freely Peer Reviewed
  • Sudden Death Due To Spontaneous Rupture Of The Urinary Bladder Following Acute Alcohol Inebriation- A Case Report And Review Of Literature

    1 Associate Professor, Department of Forensic Medicine and Toxicology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal. 

    2 Professor, Department of Forensic Medicine and Toxicology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal. 

    3 Consultant, Department of Forensic Medicine and Toxicology, Koshi Zonal Hospital, Biratnagar, Nepal. 

    Abstract

    Spontaneous rupture of the urinary bladder (SRUB) is a rare clinical condition. Prompt diagnosis is often difficult both clinically and radiologically and necessitates a high index of suspicion as the patients present with non-specific abdominal pain and may not offer a clear history. The depressant effect of alcohol further complicates the diagnosis. We report a case of a young male who was unable to seek medical support and was found dead within 12 hours of the onset of abdominal discomfort following acute alcohol intoxication. At autopsy, rupture of the urinary bladder with blood and blood clots was found in the pelvic cavity with no any corresponding external injury. Spontaneous rupture of the urinary bladder is a rare cause of death in acute alcohol intoxication. In order to further understand this rare condition, the review of related literature has been done.

    Author Contributions
    Received Oct 29, 2020     Accepted Nov 23, 2020     Published Nov 30, 2020

    Copyright© 2020 Sah Bikash, et al.
    License
    Creative Commons License   This work is licensed under a Creative Commons Attribution 4.0 International License. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Competing interests

    The authors have declared that no competing interests exist.

    Funding Interests:

    Citation:

    Sah Bikash, Jha Shivendra, Pokharel Dikshant (2020) Sudden Death Due To Spontaneous Rupture Of The Urinary Bladder Following Acute Alcohol Inebriation- A Case Report And Review Of Literature International Journal of Global Health. - 1(3):1-6
    DOI 10.14302/issn.2693-1176.ijgh-20-3612

    Results

    Results

    During the review of the literature, twelve such cases were found out of which ten cases were saved because of early diagnosis and prompt medical intervention. The findings of the reviewed literature are presented in Table 1.

    Reported cases of SRUB with outcome
    S. No. Authors Year No. of cases Outcome
    1 Bennett et al16 1980 1 Survived
    2 Munish et al14 1999 1 Survived
    3 Dooldeniya et al17 2007 3 All survived
    4 Parker et al18 2009 1 Survived
    5 Daignutt et al19 2012 1 Survived
    6 Moreno-Alarcon et al20 2014 1 Survived
    7 Muneer et al21 2015 1 Survived
    8 Ioan B et al22 2015 1 Died
    9 Zijoo et al5 2016 1 Survived
    10 Nguyen et al23 2018 1 Died
    11 Present case 2019 1 Died

    Discussion

    Discussion

    There are very few cases in the literature that portray the occurrence of SRUB due to liquor inebriation in the absence of associated traumatic bladder injury. Herein, we report a rare case of SRUB secondary to liquor inebriation, together with a review of the literatures, for a better understanding of this unusual phenomenon. This case could also have been saved if he could have gone to or have been taken to the hospital at the time he experienced the abdominal pain. Alcohol intake in this present-day world is common. Thus, along with treating doctors, the general public also need to be aware of this type of case. At the same time, different literature have further clarified different important aspects related to such cases. Uysal et al4was unable to find out the reason behind the spontaneous bladder rupture in a 78-year-old female presented with an acute abdomen. In a different case, a 26-year-old male presented with painless progressive abdominal distention; he was able to recoup fully after surgical repair of a spontaneous bladder perforation24. Parker et al. reported that bladder rupture can be associated with an experience of liquor fling25.

    The spontaneous rupture of the bladder can be facilitated by excessive liquor intake which has a diuretic effect1 and leads to overdistension from the perspective of the sensitivity disorder due to the α-sympathomimetic effect and CNS depression produced by the liquor. In a male, congestion of the prostate and prostatic urethra exaggerates the obstruction of the outlet26. However, Dooldeniya et al17reported three female cases with SRUB following liquor intake thus suggested that this type of problem should be considered among women as well. Nausea and vomiting might lead to enhanced intra-abdominal pressure and a higher probability of SRUB27. Saliba et al27 suggested that patients presenting with alcohol inebriation and acute abdomen or ascites should be considered for the differential diagnoses of SRUB.

    The review of the literature has clearly shown that most cases of spontaneous bladder rupture in affiliation with liquor intake are treated without complication when diagnosed quickly. Delayed diagnosis has led to considerable morbidity and fatality28. Different studies 191013have shown that SRUB following liquor inebriation is rare. Despite the infrequency, the cases in the literature retain consistency with regard to features at presentation, course, and appropriate treatment. It is important for treating doctors, especially of the emergency department to be aware of this particular condition due to the diagnostic and subsequent treatment difficulties. At the same time, the professionals in the field of forensic medicine have to consider this entity while giving opinions about the cause of death.

    Conclusion

    Conclusions

    This case and the review of literature have shown that most of the cases of SRUB following acute alcohol intoxication can have a positive outcome with early prediction and management whereas some cases primarily discovered during autopsy due to unawareness about it among the general public as well as difficulties of its diagnosis and its rapid evolution.

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