Abstract
Urinary bladder is the most common urologic organ exposed to iatrogenic injury. The bladder trauma is classified into extra-peritoneal, intra-peritoneal, or combined trauma. Intra-peritoneal bladder injury is conventionally being treated with open surgical repair, mainly to explore the abdominal viscera for possible associated injuries and to insert peritoneal drain. One rare form of the iatrogenic bladder injury is catheter-related bladder injury which is very uncommon and only few cases were reported. It is mainly related to other associated medical conditions like cancer and chronic catheterization which might be causing subsequent bladder wall weakness. Therefore, it is important to collect more data about this rare type of bladder injury, particularly urethral catheterization which is one of the most common medical procedures. We present a 74-year-old male patient who developed acute kidney injury and was treated by urethral catheterization in the emergency department. The patient developed immediately severe abdominal pain. Non-contrast CT showed intra-peritoneal bladder perforation by the urethral catheter. The patient developed peritonitis and failed a trial of conservative management. Consequently, laparoscopic abdominal exploration and bladder repair was performed successfully.
Highlights
Bladder trauma can result in extravasation of urine into the extra-peritoneal space (60%), intra-peritoneal space (30%) or both (10%) [1]
We present a 74-year-old male patient who developed acute kidney injury and was treated by urethral catheterization in the emergency department
Catheter-related bladder injury is an uncommon complication of urethral catheterization; it is a very devastating complication and might be fatal, if missed
Summary
Bladder trauma can result in extravasation of urine into the extra-peritoneal space (60%), intra-peritoneal space (30%) or both (10%) [1]. The patient has a medical history of chronic obstructive pulmonary disease (COPD) and diverticulosis He has a surgical history of colo-vesical fistula that was repaired by laparoscopic left hemicolectomy and closure of the fistula four years back, and transurethral resection of the prostate (TURP) two years back for lower urinary tract symptoms (LUTS) management. A cystogram was done and demonstrated the newly inserted urethral catheter to be in the correct position but there was intra-peritoneal extravasation of contrast confirming an intra-peritoneal bladder injury (Figure 2). Repeated full blood count showed normal WBCs. the patient showed clinical signs of deteriorating peritonitis and the pain became intolerable, and the score raised back to 8 out of 10. To the left filling phase and to the right post-micturition phase, both show no contrast extravasation
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