Pseudo Renal Failure Post Road Traffic Accident

Blunt abdominal trauma encompasses a broad spectrum of internal injuries, amongst which bladder rupture remains relatively infrequent, occurring in less than 2% of cases. Intraperitoneal rupture, while rare, is clinically significant—it results in urinary ascites, notable electrolyte disturbances, and azotaemia secondary to the peritoneal absorption of urinary constituents. Early identification, appropriate imaging, and rapid surgical management are critical for optimising patient outcomes. Here, we present the case of a 66-year-old male who arrived at the emergency department two days post a handlebar injury to the lower abdomen, sustained during a motor vehicle incident. The patient reported escalating abdominal pain, progressive distension, and visible ecchymosis in the suprapubic area. On examination, vital signs were stable (HR 98/min, BP 130/90 mmHg, RR 22/min, SpO₂ 98% on room air). There was marked suprapubic tenderness and fullness, raising suspicion of urinary retention. Focused Assessment with Sonography in Trauma (FAST) detected free fluid in Morrison's pouch. Laboratory studies noted hyponatremia, hyperkalaemia, and elevated creatinine—findings consistent with urinary ascites. Foley catheterisation yielded 350 mL of gross haematuria. Resuscitative measures included intravenous fluids, calcium gluconate, and insulin with dextrose for hyperkalaemia. Haemodialysis was performed due to persistent azotaemia. CT cystogram demonstrated intraperitoneal bladder rupture. The patient underwent emergency laparotomy with two-layer bladder repair and placement of an abdominal drain. Postoperative recovery was favourable: creatinine normalised, the drain was removed on postoperative day one, and the patient was discharged in stable condition. This case underscores the necessity for high clinical suspicion, targeted imaging, and aggressive metabolic correction in patients with blunt abdominal trauma and haematuria. Prompt surgical intervention remains essential for a favourable prognosis, even in the context of significant metabolic derangement.