Urinary Catheter Causing Paracentesis-induced Circulatory Dysfunction

Area of Science:

• Urology
• Gastroenterology
• Critical Care Medicine

Background:

• Acute-on-chronic liver failure and spontaneous bacterial peritonitis can lead to complex fluid management challenges.
• Urinary catheterization is a common procedure, but carries risks of iatrogenic injury.

Purpose of the Study:

• To report a rare case of bladder perforation and subsequent paracentesis-induced circulatory dysfunction due to urinary catheter misplacement.
• To highlight the importance of vigilance in urinary catheter management, especially in critically ill patients.

Main Methods:

• A 78-year-old male with liver failure underwent urinary catheterization.
• The catheter was inadvertently placed intraperitoneally, leading to significant ascitic fluid drainage.
• Diagnosis was confirmed via imaging, and the patient was treated with albumin replacement.

Main Results:

• Overnight drainage of approximately six liters of ascitic fluid occurred.
• The patient developed neurological and cardiac dysfunction.
• Bladder perforation and intraperitoneal catheter placement were identified, leading to paracentesis-induced circulatory dysfunction.

Conclusions:

• This case illustrates a rare but serious complication of urinary catheterization.
• Accurate placement and monitoring of urinary catheters are essential to prevent unintended fluid loss and circulatory compromise.
• Prompt recognition and management, including albumin replacement, are key to patient stabilization.