Inadvertent suprapubic gastrostomy: Report of a unique complication of blind percutaneous suprapubic trocar cystostomy
A 56-year-old male patient presented to our emergency department with chief complains of inability to void urine for 24 hours and vague abdominal pain. He was diagnosed as a case of acute urinary retention and was referred to the surgical team for further management. The surgical junior resident briefly examined him and attempted catheterization. After failing twice he decided to go for percutaneous suprapubic trocar catheterization. A residual volume of 2 L of coffee ground colored urine was noted on catheterization which was recorded as hematuria. Later, he was reviewed next morning when the catheter bag was found empty without any drainage for 10 hours. On further questioning he denied any history of any symptoms of bladder outlet obstruction or urinary tract infection. He never had catheterization or urethral instrumentation before and denied any history suggestive of urethritis. A per urethral catheter was inserted subsequently which went smoothly. After that he had liquid oral feed which came out through the catheter straightway. So a misplacement of the catheter was diagnosed. The suprapubic cystostomy site was found to be correct. A retrospective history suggested features of gastric outlet obstruction. He also had a previous history of upper gastrointestinal bleeding. He was anuric. We performed a laparotomy after resuscitation. On laparotomy the stomach was found to be dilated with the catheter tip along with the balloon in it []. It was a case of benign gastric outlet obstruction with a hugely distended ptotic stomach. There were also features of portal hypertension. The laparotomy was abbreviated because the patient was quite unstable intraoperatively. Feeding jejunostomy was done. A plan was made to investigate the patient further. But on the fourth postoperative day the patient had a massive upper gastrointestinal bleed from which he died in spite of all attempts for resuscitation.