• Tohru Mizumasa, Tadashi Nagara, Akihiro Tsuchimoto, Hideki Yotsueda, Tetsuro Takesue, and Hideki Hirakata.
• Nephrology & Dialysis Center, Fukuoka Red Cross Hospital, Fukuoka, Japan. ykuroki@fukuoka-med.jrc.or.jp
• Am J Emerg Med. 2012 Sep 1;30(7):1326.e1-3.

AbstractA 42-year-old man noted decreased urine output and visited our emergency department. He said that 3 days previously, he had gotten drunk and fallen down a set of stairs. Blood tests and abdominal contrast-enhanced computed tomography revealed no abnormalities. A serum creatinine level of 5.89 mg/dL led to a diagnosis of acute renal failure and his hospitalization. After admission, his ascitic fluid level gradually increased, suggesting urine leakage into the peritoneal cavity. Microscopic examination of his ascitic fluid sediment revealed the presence of hyaline casts enclosing renal tubular epithelial cells. Cystography demonstrated contrast medium leakage into the peritoneal cavity, which led to a diagnosis of bladder rupture. Examination of ascitic fluid sediment is simple and very useful for diagnosing bladder rupture.

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