Suprapubic catheterization complicated by an iatrogenic enterocutaneous fistula: a case report

BACKGROUND: Suprapubic catheterization is a common procedure employed by urologists to manage long standing voiding dysfunction or neuropathic bladders in patients. Bowel injury is a rare but important complication, in light of the consequences to patient morbidity. CASE PRESENTATION: An 81 year old Caucasian female presented with a blocked suprapubic catheter 3 weeks after passage under cystoscopic guidance. The Foley catheter was replaced and attempted aspiration brought up a faeculent fluid. There were no signs to suggest peritonitis. Catheter was kept in situ until computed tomography imaging was obtained; this illustrated the catheter in small bowel with balloon inflated, causing partial small bowel obstruction. Patient underwent exploratory laparotomy with bowel resection, with an uneventful post-operative recovery. CONCLUSION: We speculate that the injury occurred at the time of first catheter exchange, with the tip directly piercing the small bowel. To our knowledge this particular mechanism of injury has not previously been reported. This case demonstrates the importance of remaining vigilant to iatrogenic bowel injury after cystostomy, and aids initial management if injury is suspected.