[Tenckhoff catheter placed in bladder. Case and review].

Background: Stage 5 kidney disease requires renal function replacement therapy, either through hemodialysis or peritoneal dialysis. Among the complications related to the placement of a peritoneal dialysis catheter are the mechanical ones, that include flow obstruction, peritoneal fluid leak, hernias, inadequate catheter position or injury to an intra-abdominal organ. A rare complication is the accidental catheter placement in the urinary bladder. Bladder perforation is favored when there is incomplete emptying of the bladder, a surgical history, and alterations in the lower urinary tract. A case of bladder perforation after catheter placement and a review of this subject is presented.

Clinical case: 64-year-old female patient presented with Tenckhoff catheter dysfunction. She was scheduled for catheter removal and placement. During the start of the infusion of dialysis solution, the patient started to feel the urgent need to urinate. A simple abdominal tomography was requested, confirming the catheter in the bladder.

Conclusion: The risk factors for bladder injury after catheter placement are diabetes, neurogenic bladder, urinary obstruction and previous abdominal surgeries. In the presence of them, a careful approach to the cavity must be made, including bladder catheterization in cases where complete bladder emptying is not guaranteed.