•Urologists and health care professionals alike need to recognize the risks and complications that come with clot formation in urine and the use of CBI, especially subsequent bladder rupture.•Prior history of chronic, prolonged BPH has implications and complications that need to be considered when hematuria with blood clots arise and urologic procedures are performed.•This case is presented to highlight the importance of surveillance of hematuria with presence of clots, as well as the importance of regulated control of CBI. Diverticula, chronic retention, and instrumentation increase the likelihood of these complications.•Bladder rupture, although uncommonly present without trauma, is still possible and should be considered on the differential diagnosis for any patients with use of CBI or blood clots in urine.•Despite the lack of acute abdomen or urinary ascites, this patient demonstrated sub-massive bladder rupture and proved you do not need all known criteria to meet the diagnosis of intra-peritoneal rupture.
Keywords: Bladder rupture; CBI; Case report; Intra-peritoneal; Perforation.