Despite normal appearing visceral organs, the patient presented with massive ascites. After correlation with the history, CT cystogram was performed which revealed intraperitoneal bladder rupture. Retrograde urethrogram should be considered prior to CT cystogram to eliminate urethral rupture, since catheterization is contraindicated in the latter.

CT cystogram is essential to diagnose intra- or extraperitoneal rupture of bladder, it can occur before or after an IV enhanced study depending on the clinical need. At least 300 mL of contrast is necessary to detect small defects in the bladder wall.