A Case of Reverse Dialysis

A 28 yrs old lady underwent diagnostic laparoscopy as a part of evaluation for primary infertility. A midline cystic lesion was incidentally detected in the anterior abdominal wall. Post-op, patient developed abdominal distension, nausea and vomiting. Lab parameters showed elevated serum urea and creatinine. USG showed minimal ascites with normal kidney size and parenchyma. Ascitic fluid analysis revealed raised peritoneal fluid urea& creatinine levels than serum levels with peritoneal fluid - serum creatinine ratio of 3.9. CT cystography revealed extravasation of dye suggestive of urinary leak causing urinary ascites. She was diagnosed as intra op bladder rupture causing reverse dialysis resulting into pseudo-renal failure. Post laparoscopic repair, patient improved with normalisation of renal parameters. This case report aims to increase awareness of urinary ascites with any unexplained azotemia in the back ground of genitourinary surgical procedure.