A Foley Fallacy: A Case of Bladder Rupture after “Routine” Foley Catheter Placement

Abstract

Bladder injury is a rare condition mostly due to high-energy trauma. Bladder injury tends to be suspected during traumatic events in the setting of hematuria, pain, and voiding difficulty. Unfortunately, in end-stage renal disease patients who are oliguric or anuric these classic clinical findings would not be seen. We report a case of bladder rupture without a history of trauma or without a history of hematuria or voiding difficulties. To our knowledge this is the first case to describe such an injury with a lack of trauma history.

Pneumoperitoneum and peritonitis secondary to perforation of an infected bladder

“…Computed tomography usually shows free fluid [ 4 , 7 , 14 ], but pneumoperitoneum is demonstrated in 16% of the cases [ 9 ]. When diagnosis of bladder perforation is suspected, as in patients with previous bladder surgery [ 7 ], CT cystogram is the most useful diagnostic modality [ 2 , 5 , 7 , 14 ].…”

“…Rupture may even occur in the absence of manipulation in the case of urosepsis [ 1 , 2 , 6 ]. The presence of an indwelling catheter or catheterization itself certainly is a contributing factor [ 1 , [3] , [4] , [5] , [6] , [7] , [8] ] or a precipitating factor [ 10 ] in this case. However, the size of the perforation ( Fig.…”

“…In occasional cases of stable patients with a confirmed diagnosis of bladder rupture [ 2 , 4 , 5 , 7 , 10 , 14 ], conservative treatment with bladder drainage, antibiotics and supportive measures may be successfully attempted [ 4 , 7 ]. Even with proper diagnosis, surgical intervention is mandatory if the patient is unstable, deteriorating or clearly in peritonitis [ 2 , 5 ]. As in our case, if there is bladder necrosis [ 5 , 7 , 10 , 13 ], it necessitates the removal of the necrotic part of the bladder, in addition to just closing the perforation and washing the peritoneal cavity.…”

“…Catheterization or indwelling catheter may also be a risk or contributing factor for bladder rupture [ 1 , [3] , [4] , [5] , [6] , [7] , [8] ]. Among the other associated complications with bladder perforation, the occurrence of pneumoperitoneum is very unusual [ 2 , [4] , [5] , [6] , 9 , 10 ]. In majority of bladder perforation cases, clinical presentation, radiology imaging, and rarity lead to misdiagnosis as digestive tract perforation [ 2 , 6 ].…”

A Nurse-Driven Protocol for Foley Catheter Utilization Decreases the Incidence of Traumatic Foley Catheterization

“…Rarer complications include bladder rupture, perineal and bulbar artery pseudoaneurysm, intraperitoneal catheter misplacement via the verumontanum, autonomic dysreflexia in paralyzed patients, systemic infections, urethrovaginal fistula, and simultaneous bladder and small bowel perforation. [1][2][3][4][5][6][7][8][9][10] Because of the focus on the risk of catheter-associated urinary tract infections (CAUTI) and on methods to reduce the incidence of this complication, 11-13 many hospitals have implemented protocols to limit Foley catheterization days with the goal of decreasing CAUTI rates. 14,15 In May 2015, our institution instituted a nurse-driven protocol for Foley removal (Appendix).…”