Abstract
INTRODUCTION: Spontaneous bladder rupture (SBR) is a rare cause of ascites. A systematic review identified only 351 reported cases in the literature. This condition is frequently misdiagnosed due to vague symptom presentation and failure to promptly link SBR to its common risk factors, such as pelvic irradiation and alcohol intoxication. Its presentation is not different from the most common causes of ascites, and the differential diagnosis is essential. CASE PRESENTATION: Here, we present a case of a male with liver disease with portal hypertension, a previous history of cancer, and prior surgery with an artificial urinary sphincter placement who developed acute recurrent ascites and rapidly progressing acute kidney failure requiring dialysis. Extensive workup revealed that the kidney failure was caused by SBR, resulting in urinary ascites. The bladder rupture was treated by surgery, leading to complete resolution of the patient's symptoms. CONCLUSION: The diagnosis of SBR requires a high level of suspicion due to its rarity and nonspecific symptoms. Here, we present an extensive review of differential diagnoses of ascites and the pathway for the final diagnosis of SBR.