Fatal complication from Foley's catheter: a case report.

Introduction and importance: Foley's catheterization is a common and routinely performed procedure, yet it carries risks including urinary tract infection, urethral trauma, and, more rarely, bladder perforation. Reports of simultaneous bladder and bowel injury during catheter exchange are exceedingly uncommon. Case presentation: We report an 86-year-old woman with hypertension, heart failure, and a history of uterine cancer treated with chemotherapy and pelvic radiotherapy 2 decades earlier. After a routine Foley's catheter exchange, she developed paraumbilical pain and decreased urine output. She was hemodynamically stable on arrival to the emergency department, but imaging revealed a catheter-associated perforated viscus. Emergency laparotomy identified both bladder and jejunal perforations. The bladder was repaired, and the affected small bowel was resected followed by a primary anastomosis. Initially, her postoperative course was uneventful, but she developed septic shock on day 3, resulting in her death. Clinical discussion: Complications from Foley's catheter placement are rare when appropriate indications and insertion techniques are followed. The combination of bladder and bowel injury without a preexisting fistulous tract is scarcely documented in the literature. This case highlights a potentially underrecognized risk in patients with multiple risk factors such as prior radiation. Conclusion: Although simultaneous bladder and bowel injury during Foley's catheter exchange is exceptionally rare, careful patient assessment, proper insertion technique, and increasing knowledge about its indication may reduce morbidity. Increased clinician awareness of this complication may improve early recognition and outcomes.