Vol. 118, October
THE JOURNAL OF UROLOGY
Printed in U.SA.
Copyright © 1977 by The Williams & Wilkins Co.
INTESTINAL OBSTRUCTION: A COMPLICATION OF PERCUTANEOUS CYSTOTOMY. A CASE REPORT THOMAS E. MOODY, STUARTS. HOWARDS, JOEL A. SCHNEIDER
LESLIE E. RUDOLF
From the Departments of Urology and Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
The percutaneous suprapubic bladder catheter has become an important tool for the urologist because of its efficacy, simplicity and wide range of applications. A case of intestinal obstruction secondary to percutaneous cystotomy with the Bonanno suprapubic bladder drainage catheter is reported. L. C., UVH 790452, a 69-year-old man, was hospitalized in October 1976 with a bleeding gastric ulcer requiring an antrectomy and a Bilroth II gastrojejunostomy. He was discharged from the hospital 10 days postoperatively after an uneventful recovery but was readmitted 2 weeks later with pneumonia. Although a transurethral resection of the prostate had been performed previously urinary retention developed, requiring repeated catheterizations. On December 15 a Bonanno catheter* was placed percutaneously under optimal conditions according to the manufacturer's directions.' On December 25 abdominal distension occurred, requiring a nasogastric tube. Prior to this time the patient had been on oral feedings. He continued to show signs of intestinal obstruction unresponsive to long tube decompression. At surgical exploration on January 21, 1977 an atretic segment of ileum punctured by the catheter was found between the abdominal wall and the bladder. The catheter had passed through the abdominal wall, punctured the ileum and its mesentery, and had entered the bladder. It appeared that the mechanism of the bowel obstruction was that vascular compromise resulted from the catheter traversing the mesentery vessels, causing atrophy and stricture of the ileal segment. The bowel was not adherent to the bladder as might have been suspected from its unusual position (see figure). No previous pelvic or lower abdominal operation had been performed on this patient. DISCUSSION
We use the percutaneous suprapubic catheter frequently to provide bladder drainage when urethral catheterization is impossible or contraindicated, to allow continuous bladder irrigation or to perform urodynamic studies. This case illustrates the first known complication of percutaneous cystotomy at our hospital. The patient was a lean man with sparse abdominal muscles
Schematic illustration of mechanism of intestinal obstruction secondary to percutaneous cystotomy. Sagittal view (left) shows catheter traversing bowel and its mesentery before entering bladder. Anterior view (right) demonstrates narrowed segment of ileum. and the bladder was distended via a Foley catheter with 600 cc saline so that it was visible as well as palpable. The catheter was placed 2 fingerbreadths above the pubis with immediate return of saline and at no discomfort to the patient. This case has caused us to wonder if the bowel or its mesentery has been punctured in other patients without recognizable symptoms and if the extended length of time the catheter was in place allowed the injury to become manifest. In an attempt to avoid a similar complication, we now place the patient in a Trendelenberg position, in addition to following the manufacturer's instructions for suprapubic percutaneous catheter placement. REFERENCE
Accepted for publication May 27, 1977. * Bonanno Suprapubic Bladder Drainage Catheter, Becton-Dickinson, Rutherford, New Jersey.
1. Bonanno, P. J., Landers, D. E. and Rock, D. E.: Bladder drain-
age with the suprapubic catheter needle. Obst. Gynec., 35: 807, 1970.