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a b s t r a c t Premature and extremely low birth weight (ELBW) neonates are at high risk of developing multiple co-morbidities and often require urinary catheterization for various medical indications. Intra-vesical knotting of bladder catheter is a known but uncommon complication of this procedure. We report a case of an ELBW baby boy with a knotted bladder catheter requiring surgical retrieval. After an elective operation for the closure of patent ductus arteriosus, a 4 French urinary catheter was inserted into an ELBW baby boy for urine output monitoring and left in-situ. Resistance was encountered in attempt to remove the urinary catheter. Abdominal X Ray confirmed intra-vesical knotting of the tube. Knot unravelling by interventional radiology was attempted but was unsuccessful. Open extra-peritoneal bladder exploration was performed for the retrieval of the tightly knotted catheter. A 6 French transurethral Foley catheter was inserted for bladder drainage. Upon removal of the Foley's catheter on day 5 post op, the baby was able to void spontaneously. With literature review, we postulated the potential risk factors resulting in this potentially avoidable iatrogenic unusual complication. Recommendations were suggested to avoid further incidences.

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