British Journal of Radiology (2006) 79, 175-176
© 2006 British Institute of Radiology
doi: 10.1259/bjr/13576050
Misleading positioning of a Foley catheter balloon
S Abadi, MD1,
O R Brook, MD1,
E Solomonov, MD2 and
D Fischer, MD1
1 Department of Diagnostic Imaging, Rambam Medical Center, Haifa, Israel , 2 Department of Surgery, Rambam Medical Center, Haifa, Israel
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Abstract
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Indwelling catheters in the urinary bladder are associated with numerous and various complications, e.g. infection, haemorrhage, epididymo-orchitis and perforation. Abdominopelvic CT is frequently performed in hospitalized patients, with the bladder being included in the examination. Familiarity with the various bladder pathologies and a routine and meticulous search for them are indicated in every case. Moreover, an awareness of certain pitfalls may prevent over-diagnosis and over-treatment. We present a case in which a Foley catheter balloon inflated in a bladder diverticulum simulates sealed bladder perforation with extraluminal location of the balloon. This potentially misleading diagnosis should be considered in the presence of apparent extraluminal position of catheter tip or balloon not substantiated by the clinical presentation.
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Introduction
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Indwelling catheters in the urinary bladder are associated with numerous and various complications, e.g. infection, periurethral abscess, urethral diverticulum, perineal erosion, bladder atrophy, bladder stones, haemorrhage, epididymo-orchitis or urinary fistula [1, 2]. Intraperitoneal or extraperitoneal perforation can occur as a rare but life threatening complication [3]. CT is a reliable method for evaluating the bladder and demonstrating possible pathologies such as tumours, calculi, fistulas or diverticula [4].
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Case report
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We present the case of an 80-year-old man who underwent surgery for colon obstruction due to adhesions. A bladder Foley catheter was placed for drainage and haemodynamic monitoring.
A CT scan was performed 5 days following surgery, because of fever, abdominal pain and tenderness. A collection of fluid was observed in the left lower quadrant. In addition, on the pelvic axial scan, the Foley catheter was seen beyond the bladder wall, with the balloon outside its boundaries (Figure 1
). The Foley balloon was not surrounded by urine and formed an acute angle with the bladder walls. Two sequential scans were performed with a 5 h interval between them; this was related to poor bowel opacification on the initial scan. Both scans showed the balloon at the same position with the only differences being that the later scan (Figure 1b) was done with the bladder more distended with urine than the first (Figure 1a) and opacified with contrast material.
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Figure 1. Axial CT scan of the pelvis at the level of the urinary bladder(a) before and (b) after opacification with contrast material demonstrates a partially filled bladder with an inflated catheter balloon situated outside and close to its anterior wall.
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This radiological presentation was highly suggestive of extraluminal location of the balloon, i.e. perforation of the urinary bladder, and since there was no urine or contrast material around the catheter, this raised the suspicion of a sealed perforation.
However, this diagnosis did not concur with the clinical picture, as the treating surgeon reported normal, clear urine output from the catheter.
The patient was scheduled for CT guided drainage of the coincident collection several hours later. Just before the procedure, the surgeon slightly withdrew the catheter. A 3 cm bladder diverticulum arising from the anterior bladder wall was confirmed on a further limited CT scan (Figure 2). Thus, the diagnosis of intradiverticular placement of the bladder catheter balloon was made.
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Figure 2. Axial CT scan at the same level as in Figure 1 performed after repositioning of the catheter in the bladder demonstrates a distended bladder with a diverticulum arising from its anterior wall.
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Discussion
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Abdominopelvic CT is frequently performed in hospitalized patients and the bladder is included in the examination. In many cases the urinary bladder is catheterized for various indications and durations. Familiarity with the different bladder pathologies and a routine meticulous search for them are indicated in every case. Moreover, a familiarity with the various pitfalls may prevent over-diagnosis and over-treatment. We present a case in which a bladder catheter balloon inflated in a bladder diverticulum simulates sealed bladder perforation with extraluminal location of the balloon. This observation is a pitfall that should be considered in the presence of apparent extraluminal position of catheter tip or balloon not substantiated by the clinical presentation.
Received for publication January 14, 2005.
Revision received June 9, 2005.
Accepted for publication June 9, 2005.
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References
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- Lowthian P. The dangers of long-term catheter drainage. Br J Nurs 1998;7:366–8, 370, 372.[Medline]
- Winson L. Catheterization: a need for improved patient management. Br J Nurs 1997;6:1229–32, 1234, 1251–2.[Medline]
- White SA, Thompson MM, Boyle JR, Bell PR. Extraperitoneal bladder perforation caused by an indwelling urinary catheter. Br J Surg 1994;81:1212[Medline]
- Caoili EM, Cohan RH, Korobkin M, et al. Urinary tract abnormalities: initial experience with multi-detector row CT urography: Radiology 2002;222:353–60.[Abstract/Free Full Text]
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Abstract
Introduction
