Laparoscopic Repair of Catheter-Induced Intra-Peritoneal Bladder Perforation

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.

Keywords: iatrogenic bladder injury; intra-peritoneal bladder perforation; isolated bladder injury; laparoscopic urinary bladder repair; urinary catheter related complications.

Figure 1. Non-contrast CT

To the left, the axial cut view shows the inflated catheter balloon (red arrow) outside the bladder. To the right, the sagittal cut view shows the balloon (red arrow) out of the bladder.

Figure 2. Ascending cystogram - Fluoroscopy images

To the left, the oblique view of the filling phase shows contrast extravasation (red arrow). To the right, the post-micturition phase shows the contrast extravasated into the intra-peritoneal cavity (red arrow).

Figure 3. Ascending cystogram two weeks post-operative repair

To the left filling phase and to the right post-micturition phase, both show no contrast extravasation.