Intraperitoneal Urinary Bladder Perforation Observed in a Patient with an Indwelling Urethral Catheter

Soichiro Ogawa,Tomonori Date,Osamu Muraki

doi:10.1155/2013/765704

Abstract

This report describes a rare case of an 86-year-old man with an indwelling urethral catheter who developed severe abdominal pain and was diagnosed with intraperitoneal urinary bladder perforation. A home-visiting nurse suspected catheter obstruction and performed a catheter exchange. However, bladder irrigation could not subsequently be performed. Computed tomography of the abdomen and pelvis after transurethral perfusion of contrast medium demonstrated extravasation of the contrast material into the peritoneal cavity. Furthermore, the Foley catheter balloon was positioned in the peritoneal cavity through the bladder. The patient was diagnosed with peritonitis due to spontaneous intraperitoneal perforation of the urinary bladder, and exploratory laparotomy was performed. During exploration, a perforated tear at the top of the bladder was discovered where the Foley catheter had penetrated the bladder. The Foley catheter balloon was floating freely in the peritoneal cavity. There was no evidence of pathologic lesions, such as cancer or inflammatory mass at the site of the injured peritoneum. Successful closure of the damaged peritoneum and bladder was performed. Since the proportion of elderly individuals continues to increase in the general Japanese population, the incidence of the chronic Foley catheterization is expected to increase. Therefore, clinicians should be aware of this potential complication.

Highlights

Bladder perforation associated with indwelling urethral catheter is rare and can be life threatening [1], and longterm use of the urethral catheter can weaken the bladder wall
This report describes a rare case of an 86-year-old man with an indwelling urethral catheter who developed severe abdominal pain and was diagnosed with intraperitoneal urinary bladder perforation
An 86-year-old man was admitted to our hospital with sudden onset of abdominal pain that had persisted for a few hours. He had a past history of two abdominal surgeries at 21 years and 4 years earlier for appendectomy and reduction of bowel torsion, respectively. He had a history of cerebral infarction that occurred more than 20 years prior, two brain surgeries for subdural hematoma removal, and neurogenic bladder that had been managed for more than 4 months with a chronic indwelling urethral catheter

Summary

Introduction

Bladder perforation associated with indwelling urethral catheter is rare and can be life threatening [1], and longterm use of the urethral catheter can weaken the bladder wall. He had a past history of two abdominal surgeries at 21 years and 4 years earlier for appendectomy and reduction of bowel torsion, respectively He had a history of cerebral infarction that occurred more than 20 years prior, two brain surgeries for subdural hematoma removal, and neurogenic bladder that had been managed for more than 4 months with a chronic indwelling urethral catheter. His urethral catheter was exchanged for a new one by a home-visiting nurse. Laboratory testing revealed hemoglobin of 13.8 g/dL, hematocrit of 40.1%, leukocyte count of 7,300/mm, platelet count of 517,000/mm, sodium of 122 mEq/L, potassium of 4.7 mEq/L, and normal renal

Peritoneal cavity

Discussion