Gallagher Kevin M, Good Daniel W, Brush John P, Alhasso Ammar, Stewart Grant D
Department of Urology, Western General Hospital Edinburgh, Edinburgh, Mid Lothian, UK.
BMJ Case Rep. 2013 Dec 10;2013:bcr2013201436. doi: 10.1136/bcr-2013-201436.
A 77-year-old woman was referred to urology with blockages of her suprapubic catheter (SPC). The catheter was replaced easily in the emergency department, however, no urine was draining, only a cloudy green fluid was visible. On cystoscopy bilious material was identified in the bladder. There was no catheter visible. There seemed to be a fistulous tract entering the bladder at the left dome. The urethra was dilated, a urethral catheter was placed and the SPC was removed. A CT demonstrated that the SPC tract transfixed a loop of pelvic small bowel and entered the bladder with no intraperitoneal contrast leak. The patient recovered well and did not require laparotomy. This case emphasises that bowel perforation, although rare, must be considered as a complication of SPC placement even years after initial insertion when catheter problems arise. Unusually, we learn that this complication may not present with abdominal pain or peritonism.
一名77岁女性因耻骨上导尿管（SPC）堵塞被转诊至泌尿外科。在急诊科，导尿管很容易就被更换了，然而，没有尿液引出，只能看到一种浑浊的绿色液体。膀胱镜检查发现膀胱内有胆汁样物质。没有看到导尿管。似乎有一个瘘管在膀胱左穹窿处进入膀胱。尿道被扩张，放置了一根尿道导尿管，并移除了耻骨上导尿管。CT显示耻骨上导尿管通道穿透了一段盆腔小肠并进入膀胱，没有腹腔内造影剂泄漏。患者恢复良好，无需进行剖腹手术。该病例强调，尽管肠穿孔很少见，但即使在最初插入导尿管数年之后出现导管问题时，也必须将其视为耻骨上导尿管置入的一种并发症。不同寻常的是，我们了解到这种并发症可能不会表现为腹痛或腹膜炎。
