A 26-year-old woman with no prior illness presented with progressive weakness, nausea and vomiting. Evaluation revealed acute renal failure and a large amount of ascites in her abdomen. A cystogram demonstrated leakage of contrast into the peritoneal cavity, confirming bladder injury. This precipitated "reverse" autoperitoneal dialysis. She had likely sustained this injury during her uncomplicated cesarean eight days prior. Conservative treatment with bladder decompression resulted in complete reversal of the renal failure and healing of the bladder defect.