Suprapubic catheterization complicated by bowel perforation

Abstract

Inadvertent bowel injury can occur when utilizing trocar cystotomy technique for the placement of a suprapubic catheter. The authors present a patient who had a suprapubic catheter placed through a stab incision at the time of vaginal pelvic reconstruction for procidentia. Her presentation did not include the typical signs of peritonitis, but was characterized by low urine output and regression of bowel function due to ileus and third-spacing in the peritoneal cavity. The potential risk factors for bowel injury in this patient are enumerated and techniques to minimize the risk of bowel perforation are discussed. The risk of bowel injury is reduced by choosing a catheter introducer that minimizes impedance while piercing tissues, and by using a rigid cystoscope for visualization of the suprapubic trocar during entry into the bladder.