Unusual Case of Bladder Rupture Secondary to Cervical

Fibroid: A Diagnostic Challenge

Author: Dr. Asma Mushtaq

Results:

Introduction: Cervical fibroids are a less common

subtype of uterine leiomyomas, accounting for less

than 5% of cases. They are known to cause

abnormal uterine bleeding and pelvic pressure

symptoms. However, complications such as bladder

compression are more common than direct invasion

or rupture. Spontaneous bladder rupture is rare and

usually related to trauma, malignancy, or prior

instrumentation. We describe a rare case in which a

large cervical fibroid led to spontaneous rupture of

the bladder, manifesting with acute abdomen, renal

impairment, and metabolic derangement, ultimately

requiring emergency surgical intervention.

Patient Profile:

Age: 48-year-old female

Medical history: Learning difficulties, recurrent

anaemia secondary to heavy menstrual bleeding,

known cervical fibroid documented over 3 years.

Clinical Presentation: Acute lower abdominal pain for

two weeks, worsening over several days Persistent

vaginal bleeding Haematuria following

catheterisation in A&E No reported trauma or surgical

intervention

Initial Assessment:

• Tachypnoea (RR 35), low oxygen saturation (SpO₂

92% on 15L), normocardic and hypertensive

• Metabolic acidosis with elevated lactate and base

deficit

• Acute kidney injury with creatinine >1400 μmol/L

and eGFR <5

• Hyperkalaemia (K⁺ 8.2)

Investigations:

• CT abdomen and pelvis with contrast

• Bedside ultrasound

• Vaginal examination under speculum

Imaging Findings:

Large necrotic cervical fibroid (measuring approximately

20 cm) prolapsed beyond the vaginal introitus Moderate

to large volume intra-abdominal free fluid Bilateral

hydronephrosis No contrast extravasation or active

bleeding noted Intraoperative

Findings: Laparotomy revealed frank urine in the

peritoneal cavity (uroperitoneum) Bladder rupture

without visible perforation from fibroid itself, likely

secondary to chronic compression and pressure

necrosis Successful myomectomy of large cervical

fibroid Bladder repair carried out by urology

Hysterectomy deferred due to patient condition Discussion: Bladder rupture is an

uncommon complication of uterine

fibroids, especially in the absence of

surgical or traumatic history. This case

underscores the potential for large cervical

fibroids to cause chronic bladder

compression, ureteric obstruction, and

ultimately spontaneous bladder rupture.

Initial diagnosis was challenging due to the

non-specific clinical picture dominated by

AKI, and haematuria. Imaging failed to

clearly identify the bladder rupture,

necessitating exploratory surgery. The

presence of massive uroperitoneum,

confirmed intraoperatively, explained the

severe electrolyte derangement.

Conclusion: This case highlights an unusual

cause of spontaneous bladder rupture,

emphasizing the importance of

multidisciplinary assessment in complex

pelvic pathology with non-specific

presentations