2026 Volume 46 Issue 3 Pages 422-425
Bladder perforation caused by an indwelling urinary catheter is a rare but serious complication. The diagnosis is often made intraoperatively during surgery for generalized peritonitis. An 89-year-old man with a long-term indwelling catheter for benign prostatic hyperplasia was admitted to the emergency department complaining of left lower abdominal pain. A plain abdominal CT revealed free intraperitoneal air and findings suggestive of possible bladder wall penetration by the catheter. Subsequent CT urography showed contrast extravasation into the peritoneal cavity in the excretory phase, which confirmed the diagnosis of bladder perforation. Due to the stable vital signs and localized peritonitis, the patient was managed conservatively with urinary catheter replacement and broad-spectrum antibiotics. His symptoms improved promptly, and after cystoscopy confirmed closure of the perforation site, he was transferred to another facility on hospital day 35. This case serves to highlight antegrade CT urography as a useful, non-invasive method for diagnosing catheter-induced bladder perforation. It also suggests that, under strict clinical observation, conservative management can be an effective treatment option for this condition in carefully selected, hemodynamically stable patients.
