Bedside ultrasound diagnosis of atraumatic bladder rupture in an alcohol-intoxicated patient: a case report

The alcohol-intoxicated patient presents diagnostic and therapeutic challenges to the emergency physician (EP). Patients may be unable to provide a clear history and may present with nonspecific abdominal complaints that can mask an underlying disease process ranging in severity from gastritis to peritonitis. Patients with a history of recent heavy alcohol consumption may also present later in the disease course for a variety of reasons. Since high rates of mortality have been reported for cases of bladder rupture not recognized and managed early [1-3], bedside ultrasound may be useful in expediting the diagnosis and treatment of this surgical emergency.An 18-year-old male presented to the emergency department (ED) with several episodes of vomiting bright red blood and abdominal pain. He reported drinking tequila to the point of losing consciousness the previous night but denied daily drinking or the use of other recreational drugs. The symptoms began that morning when he awoke, about 1？h prior to presentation. He had blood-tinged emesis on his face and clothing and was noted to be pale and weak. The patient was born in Guatemala and denied any contributory medical, surgical, or medication history. On review of systems, the patient denied any recent trauma or falls. He denied fever, chills, diarrhea, blood in the stool, or history of gastrointestinal bleeding.At triage the vital signs were as follows: blood pressure, 106/63？mmHg; heart rate, 116 beats/min; respiratory rate, 22 breaths/min; and temperature (oral), 98.2°F. The patient was ill-appearing, grimacing in pain, and clutching his abdomen. No scleral icterus was appreciated. There was no obvious abdominal deformity or sign of trauma. Hypoactive bowel sounds were appreciated on auscultation. The abdomen was diffusely tender to palpation and more focally in the epigastrium and suprapubic areas. There was mild distension and tympany in the suprapubic area. The patient had no guarding, no rebound tenderness, and