Recurrent Ascites: Uroperitoneum as an Overlooked Etiology

Authors

DOI:

https://doi.org/10.22516/25007440.931

Keywords:

Ascites, Acute kidney injury, Uroperitoneum

Abstract

Ascites is a frequently encountered condition with diverse underlying causes. Among these, uroperitoneum is a rare etiology characterized by a non-specific clinical presentation, making it challenging to diagnose. A thorough approach and a high level of clinical suspicion are essential for accurate diagnosis. The measurement of creatinine levels in peritoneal fluid, serum, and the gradient between them plays a crucial role in achieving a correct diagnosis. In this case report, we present a patient with recurrent ascites and fluctuating elevation of azotemia, who was diagnosed with uroperitoneum through a meticulous diagnostic process. Following surgical intervention, the patient exhibited satisfactory clinical improvement without experiencing further recurrences.

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Author Biographies

Simón Hoyos-Patiño, Universidad Pontificia Bolivariana

Médico, Residente Medicina Interna. Medellín, Colombia.

Alejandra Galeano Mesa, Clínica Universitaria Bolivariana

Médico especialista en medicina interna. Médica Internista y docente auxiliar universitaria. Medellín, Colombia.

Alejandro Arango Martínez, Universidad Pontificia Bolivariana

Estudiante de Medicina. Medellín, Colombia.

References

Rudler M, Mallet M, Sultanik P, Bouzbib C, Thabut D. Optimal management of ascites. Liver Int. 2020;40(S1):128-35. https://doi.org/10.1111/liv.14361

Angeli P, Bernardi M, Villanueva C, Francoz C, Mookerjee RP, Trebicka J, et al. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406-60. https://doi.org/10.1016/j.jhep.2018.03.024

Ginés P, Quintero E, Arroyo V, Terés J, Bruguera M, Rimola A, et al. Compensated cirrhosis: Natural history and prognostic factors. Hepatology. 1987;7(1):122-8. https://doi.org/10.1002/hep.1840070124

Tarn AC, Lapworth R. Biochemical analysis of ascitic (peritoneal) fluid: what should we measure? Ann Clin Biochem. 2010;47(5):397-407. https://doi.org/10.1258/acb.2010.010048

Simler MAZ, Desouky E, Zakharious F, Mandal AKJ, Missouris CG. A Syndrome of Apparent Renal Failure. Ann Emerg Med. 2020;76(2):191-3. https://doi.org/10.1016/j.annemergmed.2020.02.018

Aithal GP, Palaniyappan N, China L, Härmälä S, Macken L, Ryan JM, et al. Guidelines on the management of ascites in cirrhosis. Gut. 2021;70(1):9-29. https://doi.org/10.1136/gutjnl-2020-321790

Runyon BA. The Serum-Ascites Albumin Gradient Is Superior to the Exudate-Transudate Concept in the Differential Diagnosis of Ascites. Ann Intern Med. 1992;117(3):215. https://doi.org/10.7326/0003-4819-117-3-215

Rodríguez Vargas BO, Monge Salgado E, Montes Teves P, Salazar Ventura S, Guzmán Calderón E. Diagnostic of ascites due to portal hypertension: accuracy of the serum-ascites albumin gradient and protein analises in ascitic fluid. Rev Gastroenterol Peru. 2014;34(1):23-8.

Hou W, Sanyal AJ. Ascites: Diagnosis and Management. Medical Clinics of North America. 2009;93(4):801-17. https://doi.org/10.1016/j.mcna.2009.03.007

Kant S, Menez S, Hanouneh M, Fine DM. Close encounters of the peritoneal kind: case series and literature review of uroperitoneum. Lessons for the clinical nephrologist. J Nephrol. 2021;34(3):939-42. https://doi.org/10.1007/s40620-020-00867-1

Ridinger HA, Kavitt RT, Green JK. Urinary Ascites and Renal Failure from Unrecognized Bladder Rupture. Am J Med. 2012;125(9):e1-2. https://doi.org/10.1016/j.amjmed.2012.01.019

Charalampidis S, Petrides C, Charalampous C, Stavrou S. Hyponatremic Renal Pseudofailure and Massive Ascites Following Normal Vaginal Delivery: A Diagnostic and Therapeutic Challenge. Renal Failure. 2012;34(2):237-40. https://doi.org/10.3109/0886022X.2011.647206

Manahan K. Peritoneal fluid urea nitrogen and creatinine reference values. Obstetrics & Gynecology. 1999;93(5):780-2. https://doi.org/10.1016/S0029-7844(98)00516-X

Nguyen-Khac E, Thevenot T, Capron D, Dharancy S, Paupart T, Thabut D, et al. Are ascitic electrolytes usable in cirrhotic patients? Correlation of sodium, potassium, chloride, urea, and creatinine concentrations in ascitic fluid and blood. European J Int Med. 2008;19(8):613-8. https://doi.org/10.1016/j.ejim.2007.07.011

Martens P. Pseudorenal Failure Secondary to Reversed Intraperitoneal Autodialysis. Case Rep Nephrol. 2013;2013:1-3. https://doi.org/10.1155/2013/982391

Kim JH, Yang WJ. Delayed spontaneous perforation of urinary bladder with intraperitoneal seeding following radical transurethral resection of invasive urothelial cancer: a case report. BMC Res Notes. 2014;7(1):167. https://doi.org/10.1186/1756-0500-7-167

Pogatchnik B, Monti S, Lewis DH, Heinrich DA, Mannelli L. Intraperitoneal Urine Leak After Prostatectomy Confirmed by 99mTc-MAG3 Renogram. Clinical Nuclear Medicine. 2014;39(8):744-6. https://doi.org/10.1097/RLU.0000000000000442

Teeluckdharry B, Gilmour D, Flowerdew G. Urinary Tract Injury at Benign Gynecologic Surgery and the Role of Cystoscopy: A Systematic Review and Meta-analysis. Obstetrics & Gynecology. 2015;126(6):1161-9. https://doi.org/10.1097/AOG.0000000000001096

Rajasekar D, Hall M. Urinary tract injuries during obstetric intervention. BJOG. 1997;104(6):731-4. https://doi.org/10.1111/j.1471-0528.1997.tb11986.x

Cohen AJ, Packiam VT, Nottingham CU, Pariser JJ, Faris SF, Bales GT. Iatrogenic Bladder Injury: National Analysis of 30-Day Outcomes. Urology. 2016;97:250-6. https://doi.org/10.1016/j.urology.2016.05.002

Harding AE, Scott J, Jefferson M. Bladder rupture in multiple sclerosis. BMJ. 1977;1(6056):270-270. https://doi.org/10.1136/bmj.1.6056.270

Bastable JRG, Jode LRD, Warren RP. Spontaneous rupture of the bladder. Brit J Urol. 1959;31(1):78-86. https://doi.org/10.1111/j.1464-410X.1959.tb09386.x

Fujikawa K, Yamamichi F, Nonomura M, Soeda A, Takeuchi H. Spontaneous Rupture of the Urinary Bladder Is Not a Rare Complication of Radiotherapy for Cervical Cancer: Report of Six Cases. Gynecologic Oncology. 1999;73(3):439-42. https://doi.org/10.1006/gyno.1999.5347

Lin ACM, Juang GD, Huang CH, Tso CY. An unusual cause of iatrogenic bladder rupture. Am J Emerg Med. 2006;24(4):512-4. https://doi.org/10.1016/j.ajem.2005.11.018

Sivakumar V, Sivaramakrishna G, Abirami K, Lakshmi A. Urinary ascites. Indian J Nephrol. 2012;22(2):143. https://doi.org/10.4103/0971-4065.97140

Bourgeois S, Decupere M, Devriendt D, Lesage K, Van Moerkercke W. A case of pseudorenal failure - spontaneous rupture of the urinary bladder. Acta Gastroenterol Belg. 2017;80(3):419-21.

Mischianu D, Bratu O, Ilie C, Madan V. Notes concerning the peritonitis of urinary aetiology. J Med Life. 2008;1(1):66-71.

Mark A, Meister M, Opara B, Chow R. Nontraumatic urinary bladder rupture presenting as renal pseudo-failure and ascites. Radiology Case Reports. 2017;12(2):304-7. https://doi.org/10.1016/j.radcr.2017.03.005

Goto S, Yamadori M, Igaki N, Kim JI, Fukagawa M. Pseudo-azotaemia due to intraperitoneal urine leakage: a report of two cases. NDT Plus. 2010;3(5):474-6. https://doi.org/10.1093/ndtplus/sfq107

Wang YC, Lin JD, Hung SC. A woman with ascites and oliguria. Clin Kidney J. 2013;6(5):545-6. https://doi.org/10.1093/ckj/sft103

Wystrychowski A, Nowicki M, Kokot F. Hyponatraemic renal pseudofailure--don’t forget the possibility of uroperitoneum. Nephrol Dial Transplant. 1996;11(12):2491-2. https://doi.org/10.1093/oxfordjournals.ndt.a027222

Eymin LG, Trucco BC, Andresen HM. Ascitis y falla renal: no olvidar el uroperitoneo. Rev Méd Chile. 2006;134(3):345-347. https://doi.org/10.4067/S0034-98872006000300012

Quagliano PV, Delair SM, Malhotra AK. Diagnosis of Blunt Bladder Injury: A Prospective Comparative Study of Computed Tomography Cystography and Conventional Retrograde Cystography: J Trauma. 2006;61(2):410-21. https://doi.org/10.1097/01.ta.0000229940.36556.bf

Fouladi DF, Shayesteh S, Fishman EK, Chu LC. Imaging of urinary bladder injury: the role of CT cystography. Emerg Radiol. 2020;27(1):87-95. https://doi.org/10.1007/s10140-019-01739-3

Ajape A, Abdulkadir A, Babata A, Adesiyun O. Spontaneous Intra-Peritoneal Urinary Bladder Rupture Complicating Benign Prostate Hyperplasia: Case Report. Ann Afr Surg. 2011;7(1):62-5. https://doi.org/10.4314/aas.v7i1.67034

Figure 1. Voiding cystography. Authors’ archives.

Published

2023-06-22

How to Cite

Hoyos-Patiño, S., Galeano Mesa, A., & Arango Martínez, A. (2023). Recurrent Ascites: Uroperitoneum as an Overlooked Etiology. Revista Colombiana De Gastroenterología, 38(2), 211–216. https://doi.org/10.22516/25007440.931

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Case report

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