Intra-vesical knot of bladder catheter in an extremely low birthweight neonate: A case report

Abstract

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.

Knotting of a urethral catheter

“…Ayaka Monoi, 1 Masahiro Sugawa, 1 Motohiro Kato, 1,2 Masafumi Seki, 1 Kenichi Yoshida, 4 Yuichi Shiraishi, 3 Hirotoshi Sakaguchi, 5 Dyskeratosis congenita (DC) is a rare disease involving bone marrow failure caused by dysfunction of genes maintaining telomere length. 1 Bone marrow failure is the main symptom of DC, and DC is also characterized by the triad of nail atrophy, oral leukoplakia and reticular skin pigmentation.…”

“…Various techniques to remove the knotted catheters have been described, including manual extraction, and insertion of a guidewire inside the catheter to untangle the knot . Open surgical procedures with cystostomy or urethrostomy were reluctantly chosen when the less invasive procedures were unsuccessful. The systemic steroid treatment used in the present case might increase the success rate for manual extraction by reducing the edema of the urethral lumen where the catheter is lodged.…”

Spontaneous Intravesical Knotting of a Feeding Tube in a Late Preterm Neonate: A Case Report

“… 1 Urinary catheterization is often required to relieve fluid retention, to collect urine, and occasionally for radiological studies. 2 FTs sizes Fr 5, Fr 6, or Fr 8 are commonly used due to their availability and ease of use. 3 Although the procedure is safe, complications have been reported, including trauma during insertion, hematuria, and tube knotting within the urinary bladder.…”

Spontaneous Knotting of a Foley Catheter in the Urinary Bladder: A Case Report

“…Methods have been proposed such as un-knotting using fluoroscopic or endoscopic guidance or Supra pubic cystotomy retrieval [6,8]. But these methods are invasive and are more difficult to perform in resource limited settings.…”

“…Subsequently the catheter coils tighten into a knot when the catheter is pulled [5,6]. Our patient had agitation due to his head injury.…”