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| Year : 2013 | Volume
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| Issue : 2 | Page : 373-375 |
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| Accidental placement of the continuous ambulatory peritoneal dialysis catheter into the urinary bladder |
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Syed Aijaz Nasir1, M Ashraf Bhat1, Muzafar M Wani1, Syed Tufail1, Imtiyaz A Wani1, Suhail Mantoo2
1 Department of Nephrology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, Kashmir, India
2 Department of Medicine, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, Kashmir, India
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| Date of Web Publication | 26-Mar-2013 |
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How to cite this article:
Nasir SA, Bhat M A, Wani MM, Tufail S, Wani IA, Mantoo S. Accidental placement of the continuous ambulatory peritoneal dialysis catheter into the urinary bladder. Saudi J Kidney Dis Transpl 2013;24:373-5 |
How to cite this URL:
Nasir SA, Bhat M A, Wani MM, Tufail S, Wani IA, Mantoo S. Accidental placement of the continuous ambulatory peritoneal dialysis catheter into the urinary bladder. Saudi J Kidney Dis Transpl [serial online] 2013 [cited 2022 May 23];24:373-5. Available from: https://www.sjkdt.org/text.asp?2013/24/2/373/109609 |
To the Editor ,
Continuous ambulatory peritoneal dialysis (CAPD) is one of the modalities of renal replacement therapy for patients with end-stage renal disease (ESRD). Many techniques exist for the insertion of CAPD catheters. Although open surgical methods were most commonly used in the past, percutaneous and laparoscopic methods are gaining increasing popularity more recently. [1],[2],[3],[4],[5],[6],[7],[8],[9] Percutaneous procedure has the advantage of having a lower cost and requiring a shorter duration of hospitalization. [3] Blind techniques have the disadvantage of not being able to visualize the peritoneal cavity. Consequently, these techniques are associated with multiple complications such as peritonitis, tunnel infections, catheter migration, malposition, etc. An important group of these complications is related to the insertion of the catheter. Malposition of the catheter into the urinary bladder is a rare complication and we herewith report a case with this complication.
A 75-year-old man with ESRD secondary to diabetic nephropathy was put on CAPD. Prior to catheter placement, the patient was advised to completely empty his urinary bladder. Prophylactic antibiotic therapy was administered. Insertion of the Tenckhoff swan-neck double-cuff pigtail catheter was performed under local anesthesia by standard blind implantation procedure using a trocar through a small infraumbilical incision in the rectus fascia, after instillation of 1 L of saline into the peritoneal cavity. Following insertion of the catheter, saline was injected into the catheter without encountering any resistance. After five days of catheter implantation, the patient developed two episodes of hematuria, which subsided on its own. After commencement of CAPD (one week after insertion of the catheter), with initial input of 500 mL of dialysate fluid, the patient complained of urinary urgency. With the subsequent increase in input volume of the dialysate, there was a marked increase in urinary volume. Plain X-ray of the abdomen showed that catheter was positioned in the pelvis. Ultrasonogram (USG) of the pelvis showed that the tip of the catheter had pierced the wall of the bladder, which was confirmed by cystography [Figure 1], [Figure 2], and [Figure 3]. | Figure 1: Ultrasonogram of the pelvis showing the position of CAPD and Foley catheters in the urinary bladder.
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 | Figure 2: The CAPD catheter tip seen in the urinary bladder with a small tear seen in the right superolateral wall of the urinary bladder.
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 | Figure 3: Instillation of contrast through the peritoneal catheter showing the position of the catheter in the urinary bladder.
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Patient was put on urinary indwelling catheter and the peritoneum was opened. The CAPD catheter was removed and it was planned to re-implant the catheter after two to three weeks. Meanwhile, the patient was transferred to hemodialysis.
Complications of CAPD using the Tenckhoff catheter may be classified as infectious or mechanical. [4] Mechanical complications are mostly catheter-related and include obstruction to flow, leakage of the peritoneal fluid, ventral and inguinal hernias, catheter malposition or malfunction, and intra-abdominal organ injury. [2],[4] Most mechanical complications occur during the first month after catheter placement. [1] Risk factors for organ perforation are previous abdominal surgery, past history of peritonitis and neurogenic bladder. Infusing dialysis solution into the peritoneal cavity before catheter insertion reduces the incidence of this complication. [4] Accidental placement of the peritoneal catheter in the urinary bladder is a very rare complication. Neurogenic bladder is seen frequently in long-standing diabetic patients. This increases the risk of inadvertent puncture of the bladder in these patients. Catheterization of the bladder prior to CAPD catheter insertion may be useful in patients with suspected atonic bladder to decrease the likelihood of inadvertent bladder perforation. [8]
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| 4. | Bullmaster JR, Miller SF, Finley RK Jr, Jhones LM. Surgical aspect of the Tenckhoff peritoneal dialysis catheter. A 7 year experience. Am J Surg 1985;149:339-42.
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Correspondence Address:
Syed Aijaz Nasir
Department of Nephrology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, Kashmir
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1319-2442.109609
[Figure 1], [Figure 2], [Figure 3] |
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| This article has been cited by | | 1 |
Accidental Insertion of a Peritoneal Dialysis Catheter in the Urinary Bladder |
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| Shivraj Riar, Mohammed Abdulhadi, Christine Day, Bhanu Prasad | | Case Reports in Nephrology and Dialysis. 2018; 8(1): 76 | | [Pubmed] | [DOI] | |
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