Iatrogenic bladder trauma (IBT), a rare complication of Caesarean delivery (CD), can present with delayed symptoms, posing diagnostic challenges. A case study reports IBT presenting six days post-CD, initially undetected by retrograde cystography and CT urography. Subsequent surgical exploration revealed an 8-cm wound in the bladder dome, concealed by a hematoma and enlarged uterus. While retrograde cystography is typically accurate, false negatives may occur. CT cystography offers higher sensitivity but may still miss small perforations. Delayed IBT can manifest with abdominal pain, hematuria, and elevated renal function tests, warranting clinical suspicion and consideration of surgical exploration despite negative imaging. © 2024 The Authors