Case Report: Bladder perforation in an extremely preterm neonate secondary to multifactorial etiology

Background Neonatal bladder perforation is a rare but life-threatening condition associated with significant morbidity if not promptly recognized. Case presentation We report the case of an extremely preterm male infant born at 26 weeks of gestation who developed bladder perforation on day 15 of life, presenting with abdominal distension, decreased urine output, and respiratory distress. The diagnosis was confirmed by fluoroscopic voiding cystourethrogram demonstrating contrast extravasation into the peritoneal cavity. The etiology was multifactorial, involving extreme prematurity, umbilical arterial catheterization, repeated urinary catheter insertions, and heavy sedation. Initial conservative management with urinary catheterization and broad-spectrum antibiotics was followed by successful surgical repair via exploratory laparotomy on day 23 of life. Conclusion This case highlights the importance of maintaining a high index of suspicion for bladder perforation in extremely preterm neonates presenting with ascites and sepsis-like features, particularly in the presence of multiple iatrogenic risk factors. Early diagnosis and timely intervention are critical for optimizing outcomes.