Ascitic fluid with ammonia odor as a symptom of bladder rupture.
Case
An 88-year-old woman presented with abdominal pain, massive ascites, and acute kidney injury. She was clinically hypervolemic and the computed tomography attenuation value of the ascites was near that of water. Subsequent abdominocentesis revealed ammonia-smelling ascites fluid, leading to a suspicion of urinary tract injury, and a conclusive diagnosis of spontaneous bladder rupture was achieved using cystography.


Outcome
The patient was managed conservatively with antibiotics, percutaneous drainage, and bladder catheter. As a result, she was discharged with normal renal function.


Conclusion
The diagnosis of bladder rupture is difficult, and is rarely confirmed in the absence of a diagnostic suspicion. This case indicates that ascitic fluid odor, patient volume status, and the computed tomography attenuation value of ascites are potential indicators of bladder rupture.
['Mizumura|Naoto|N|', 'Imagawa|Atsuo|A|', 'Kawasaki|Masayasu|M|', 'Okumura|Satoshi|S|', 'Toyoda|Sho|S|', 'Ogawa|Masao|M|']
ammonia odor bladder rupture computed tomography attenuation values Abdominocentesis volume status