Presentation
Quadriplegic patient with abdominal pain and sepsis
Patient Data
No evidence of pneumoperitoneum. There is mottled abnormal gas outlining the
lateral border of the left kidney, extending inferiorly over the left side of
the abdomen and pelvis. This is suspected to be retroperitoneal in location.
There is also abnormal gas projected over the right inferior pelvis.
The bowel gas pattern is unremarkable. No radiopaque calculi over the renal
tracts.
Moderate amount of intra-abdominal but extraperitoneal fluid and gas are seen
throughout the left flank, thought to originate from anterolateral wall of
dilated urinary bladder which shows nearly circumferential mural gas suggestive
of emphysematous cystitis. There is a small amount of gas also present at
the anteroinferior margin of the spleen, possibly gas having dissected into the
peritoneal space here. There is no intraperitoneal gas elsewhere. Minor amount
of intraperitoneal ascites in Morison's pouch and bilateral paracolic gutters.
Minor presacral edema. Suprapubic catheter in situ. Recommend correlation with
suprapubic catheter function. Mild bilateral hydroureteronephrosis. Otherwise normal appearance of bilateral kidneys.
PROCEDURE AND FINDINGS:
The patient was placed supine on the fluoroscopy table. After standard aseptic
precautions, the initial injection of the existing catheter demonstrated that it was
located within the urethra.
The catheter was cut and removed over a wire. A new 14 French suprapubic
catheter was inserted with the tip located within the bladder. The wire was
removed and system was decompressed. A sample of urine was obtained for
analysis. A dressing was applied. The patient tolerated the procedure and there were no
immediate complications.
IMPRESSION:
The tip of the patient's previous suprapubic catheter was located within the
urethra which resulted in the obstruction and findings on the recent CT.
A technically successful exchange of the catheter was performed with the tip now
located in an appropriate position in the bladder.
Case Discussion
Emphyematous cystitis is an unusual cause of pneumoretroperitoneum.
The underlying cause in this case was urethral obstruction by a suprapubic catheter.
This case emphasizes the importance of confirming correct position of indwelling catheters and lines on imaging studies.
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