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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2013  |  Volume : 24  |  Issue : 2  |  Page : 373-375
Accidental placement of the continuous ambulatory peritoneal dialysis catheter into the urinary bladder


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 Publication26-Mar-2013
 

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 2019 Nov 14];24:373-5. Available from: http://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]

 
   References Top

1.Allon M, Soucie JM, Macon EJ. Complications with permanent peritoneal dialysis catheters: Experience with 154 percutaneous placed catheters. Nephrol 1988;48:8-11.  Back to cited text no. 1
[PUBMED]    
2.Bamberger MH, Sullivan B, Padberg FT Jr, Yudd M. Iatrogenic placement of a Tenckhoff catheter into the urinary bladder of a diabetic patient after penectomy. J Urol 1993;150: 1238-40.  Back to cited text no. 2
[PUBMED]    
3.Banli O, Altum H, Oztemel A. Early starting of CAPD with Seldingr technique. Perit Dial Int 2005;25:556-9.  Back to cited text no. 3
    
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.   Back to cited text no. 4
    
5.Cronen PW, Moss JP, Simpson J, Rao M, Cowels L. Tenckhoff catheter placement: Surgical aspects. Am Surg 1985;51:627-9.  Back to cited text no. 5
    
6.Francis DM, Donnelly PK, Veitch PS, et al. Surgical aspects of continuous ambulatory peritoneal dialysis. 3 years experience. Br J Surg 1984;71:225-9.   Back to cited text no. 6
[PUBMED]    
7.Moreiras M, Cuina L, Rguez Goyanes G, Sobrado JA, Gil P. Inadvertent placement of a Tenckhoff catheter into the urinary bladder. Nephrol Dial Transplant 1997;12:818-20.  Back to cited text no. 7
    
8.Rouse J, Walker R, Packer S. Inadvertent intravesical insertion of a Tenckhoff catheter. Perit Dial Int 1996;16:186-7.  Back to cited text no. 8
[PUBMED]    
9.Sanderson MC, Swartzendruber DJ, Fenoglio ME, Moore JT, Haun WE. Surgical compli-cations of continuous ambulatory peritoneal dialysis. Am J Surg 1990;160:561-6.  Back to cited text no. 9
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Correspondence Address:
Syed Aijaz Nasir
Department of Nephrology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, Kashmir
India
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DOI: 10.4103/1319-2442.109609

PMID: 23538368

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  [Figure 1], [Figure 2], [Figure 3]



 

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