Catheterised hutch diverticulum masquerading as intraperitoneal bladder perforation

Some possible aetiologies include gonorrhoeal infection, radiation therapy, diabetes mellitus, neurogenic bladder, bladder diverticula, and indwelling urinary catheter.1 2 As our patient was largely pain-free with minimal abdominal symptoms, the overall clinical evidence did not favour bladder rupture even though the CT images were alarming. Saline instillation and bedside ultrasound for rapid disposition of polytrauma patients and early diagnosis of bladder rupture has been described in the literature, with sensitivity reaching 90%.3 In cases with low clinical risk for perforation and when the patient is unfit for immediate CT, instillation of sterile saline to distend the bladder followed by ultrasound assessment provides a possible alternative to exclude bladder perforation. In experienced hands, following retrograde instillation of approximately 300 mL of sterile saline via the catheter, this imaging modality can be used to determine presence of ascites, evaluate the distension and configuration of the urinary bladder, look for bladder diverticula, and determine the position of the catheter balloon.