historically , ileal conduit formation following radical cystectomy has been the preferred type of urinary diversion . more recently , orthotopic bladder reconstruction has become increasingly popular , affording patients continence , maintaining as much normal voiding function as possible , with a more desirable body image and good quality of life [ 13 ] . a 71-year - old male had undergone a radical cystectomy and orthotopic neobladder formation 5 years previously , and was self - catheterising . he presented to the emergency department with a 24-h history of abdominal pain and distension . examination revealed a distended abdomen with some lower abdominal tenderness but no evidence of peritonism . relevant blood analysis revealed creatinine 354 mol / l , wcc 15.9  10/l and crp > 380 . an abdominal x - ray revealed dilated small bowel loops , and a ct showed moderate volume ascites and distal small bowel obstruction with the transition being a thickened small bowel loop lying next to the neobladder ( fig .  1 ) . figure  1:ct scan showing transition point of dilated bowel lying adjacent to the neobladder . conservative management was instituted ( catheter , nasogastric tube ) for presumed adhesional obstruction , and the patient was admitted under the care of the general surgical team . the urology team were contacted in light of the ct findings , and as the patient had not improved over a 24-h period , a decision was made to proceed with an exploratory laparotomy . at surgery , there was a large amount of turbid urinary ascites , and the offending loop of small bowel seen on the ct was found to be stuck to a 5 mm perforation in the neobladder , at the junction of the afferent limb and the pouch . the patient made a good recovery , creatinine normalized to 95 mol / l , bowel function returned to normal and a cystogram at 10 days did not show any evidence of a leak . presenting features generally include fever and anuria , with abdominal pain being the main symptom . possible causes of spontaneous rupture include overdistension , adhesions causing tearing of the neobladder wall and blunt trauma . in the vast majority of cases , exploratory laparotomy and repair is required ; however , there have been two reported cases of successful conservative management [ 5 , 6 ] . in this case , a segment of ileum became adherent to the neobladder , leading to bowel obstruction . it is difficult to postulate whether the adhesion caused tearing of the neobladder , or spontaneous rupture occurred first leading to subsequent adherence of the ileum . this case highlights the importance of early urological input and a high index of suspicion of neobladder perforation in any such patient with abdominal symptoms , regardless of their nature .
orthotopic bladder reconstruction is becoming increasingly popular in patients who have undergone radical cystectomy . 
 one of the rare complications is spontaneous rupture , which presents with various symptoms , but in particular , abdominal pain . 
 we report a case of orthotopic bladder perforation in a patient who presented with the symptoms and signs of small bowel obstruction .