An 83 year old woman with sepsis and acute kidney injury is being managed in your resuscitation area. A urinary catheter has been placed to monitor urine output. After an hour there is no urinary output at all.
The possibility of bilateral ureteric obstruction with subsequent anuria is raised. You have a look.
Describe and interpret these scans
Image 1: Transverse bladder view fanning inferiorly to superiorly. The bladder contains urine but no catheter. Beginning at the base of the bladder the catheter balloon is seen inflated within the vagina. As it is followed superiorly the distal tip of the catheter is seen lying in the left anterior vaginal fornix.
The urinary catheter is removed and reinserted into the urethra and bladder with resolution of their anuria. Mystery solved!
Misplaced urinary catheter
In Emergency Medicine ultrasound is routinely used to assess patients with acute renal failure. Its role is generally to ensure there is no post renal cause such as bladder outflow obstruction or bilateral ureteric obstruction. It can also easily determine the location of urinary catheters. The balloon is easily identified and usually contains a small amount of air, but mainly water.
I have seen “anuric” patients with the catheter balloon lying within the prostatic urethra, in the vagina and in the pelvis after passing through the bladder wall in a post Caesarean section misadventure. I have also seen suprapubic catheters lying within the abdominal wall tract, and on several occasions passing into the bladder and then on down into the urethra prior to being inflated. Ultrasound has been invaluable in these cases.