Iatrogenic perforation of the bladder wall following urinary catheter placement
Presentation
Suprapubic pain with tenderness 12 hours following insertion of a urinary catheter in a patient with a known benign prostatic hypertrophy.
Patient Data
The ultrasound demonstrates:
- prostatic hypertrophy ( volume around 80 mL) of heterogeneous echotexture
- thickened trabeculated bladder wall
- the balloon of the Foley catheter is seen above the dome of the urinary bladder
- numerous small simple hepatic cysts are noted
The CT scan demonstrates a definite perforation of the urinary bladder. The Foley catheter tip is located above the bladder dome with a small extraperitoneal fluid collection (urinoma) is noted on the left side of the Foley catheter tip. There is also perforation of the adjacent peritoneal reflections well-visualized on sagittal reconstruction with mild free intraperitoneal fluid and fat stranding which may indicate peritonitis.
Prostatic hypertrophy as seen on ultrasound.
Other incidental findings:
- sliding hiatal hernia
- numerous small simple hepatic cysts
- numerous small colonic diverticula
- small left inguinal hernia
Case Discussion
Ultrasound and CT features of perforation of the urinary bladder following the placement of a Foley catheter with urinoma and signs of peritonitis.
Urinary bladder perforation is considered as a rare injury 1. The peritoneal dome of the urinary bladder is the weakest zone which is vulnerable to injury 2.
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