Traumatic Intraperitoneal Bladder Rupture Presenting With Massive Ascites and Acute Kidney Injury Following a Ground-Level Fall.

A previously healthy 39-year-old man presented with progressive abdominal distension and discomfort one week after a high-velocity ground-level fall. He initially sought care elsewhere but was discharged without a definitive diagnosis. On presentation to our institution, he exhibited signs of acute kidney injury, abdominal compartment syndrome, and elevated intra-abdominal pressure. Point-of-care paracentesis revealed 7.9 L of fluid with markedly elevated creatinine, consistent with urinary ascites. A CT urogram confirmed bladder dome rupture. The patient underwent exploratory laparotomy with successful bladder wall and peritoneal repair. Postoperatively, he improved without the need for dialysis. This case illustrates an uncommon but critical diagnosis of intraperitoneal bladder rupture following blunt abdominal trauma, masquerading as acute kidney injury due to reverse autodialysis. Recognition of urinary ascites and early surgical intervention can prevent misdiagnosis and irreversible renal injury.