A Rare Post-Cesarean Encounter: Bladder Flap Hematoma

Abstract

Background: Bladder-flap hematoma (BFH) is a rare postoperative complication of cesarean section, occurring in approximately 0.5–1% of cases. It results from bleeding within the vesicouterine space due to inadequate hemostasis or vessel injury during uterine closure. Although cesarean section is a lifesaving procedure, the global rate has risen to nearly 21% of all births and is projected to reach 29% by 2030, thereby increasing the likelihood of encountering such complications.

Case Presentation: A 25-year-old woman (G2P1L1) at 38 weeks and 4 days of gestation with a previous lower segment cesarean section underwent an emergency cesarean for fetal distress. Intraoperatively, a bleeding vessel near the uterine incision was ligated. Within hours, she developed hematuria while remaining hemodynamically stable. Ultrasonography and contrast-enhanced CT revealed a 130–135 mL collection between the bladder dome and the anterior uterine wall, consistent with a bladder-flap hematoma. Following multidisciplinary evaluation, conservative management with ultrasound-guided pigtail drainage was performed, resulting in clinical stability and near-complete resolution by postoperative day 16.

Conclusion: This case underscores that even though bladder-flap hematoma is rare, its presentation can closely resemble major surgical complications. Hematuria should prompt immediate evaluation to avoid misdiagnosis. Early imaging and multidisciplinary management are crucial for accurate diagnosis, optimal recovery, and prevention of unnecessary surgical intervention.