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Journal of Indian Association of Pediatric Surgeons
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Year : 2012  |  Volume : 17  |  Issue : 4  |  Page : 174-175

Successful management of auto knotted intravesical infant feeding tube by minimal invasive technique

Department of Urology, IPGME and R, Kolkata, West Bengal, India

Date of Web Publication13-Oct-2012

Correspondence Address:
Sidharth Khullar
Room No. 129, Junior Doctors Hostel, 242 A.J.C. Bose Road, Kolkata, West Bengal-700 020
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0971-9261.102341

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We report a case of acute urinary retention due to intravesical auto knotting of infant feeding tube in a child treated successfully by endoscopic approach.

Keywords: Clean intermittent catheterization, infant feeding tube, intravesical auto knotting

How to cite this article:
Khullar S, Bera MK, Kundu AK, Pal DK. Successful management of auto knotted intravesical infant feeding tube by minimal invasive technique. J Indian Assoc Pediatr Surg 2012;17:174-5

How to cite this URL:
Khullar S, Bera MK, Kundu AK, Pal DK. Successful management of auto knotted intravesical infant feeding tube by minimal invasive technique. J Indian Assoc Pediatr Surg [serial online] 2012 [cited 2023 Sep 28];17:174-5. Available from: https://www.jiaps.com/text.asp?2012/17/4/174/102341

   Introduction Top

Clean intermittent catheterization (CIC) is often utilized in neurogenic bladder. [1] Intravesical knotting is a rarely reported complication of CIC but it can cause significant morbidity. [2],[3],[4]

   Case Report Top

A four year old male child with neurogenic bladder was on regular clean intermittent catheterization (CIC) with infant feeding tube (5F) by the mother for the past six months. The child was brought to emergency with acute urinary retention following inability to withdraw infant feeding tube after introduction for drainage of bladder. An ultrasonography showed feeding tube knotted and impacted at bladder neck and a plain radiograph [Figure 1] confirmed the findings. The feeding tube was cut at urethral meatus and pushed into the urinary bladder with another 8F Foley's catheter and it was kept in situ for relief of urinary retention. Subsequently under general anesthesia, cystoscopy was done and the knotted infant feeding tube was identified [Figure 2]. A 5 mm laparoscopic port was introduced into the urinary bladder in the supra pubic region under cystoscopic guidance. The knotted part of feeding tube cut with laparoscopic scissors and unknotting done with Maryland forceps, followed by removal of two pieces of infant feeding tube through same port. The supra pubic port closed and child was catheterized after the procedure. The postoperative period was uneventful and the urethral catheter removed after 72 hours.
Figure 1: Anteroposterior view of plain X-ray pelvis showing impacted infant feeding tube in bladder neck

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Figure 2: Cystoscopic picture showing knotted infant feeding tube in urinary bladder

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   Discussion Top

CIC is commonly done in children with neurogenic bladder dysfunction. Infant feeding tube knotting is a very rare event. [5] It gets knotted when excessive length of flexible catheter is inserted in the bladder and forms a loop; subsequently as the catheter is withdrawn a knot can form and tightens on withdrawal leading to impaction of the catheter. Removal of infant feeding tube has been tried in many ways, e.g. supra pubic cystostomy, manual removal of catheter with gentle traction under local/general anesthesia or the infant feeding tube is uncoiled by passing a guide wire in infant feeding tube and straightening it, but fails if the knot is tight. [6]

It is best to prevent this problem by totally avoiding the use of infant feeding tube or by introducing only short length of feeding tube to drain the bladder. A 6-10F Foley's catheter may be better option. A high index of suspicion is required to diagnose knotting of infant feeding tube when it cannot be withdrawn easily. This will prevent traumatic urethral injury due to forcible removal and subsequent risk of urethral stricture.

   References Top

1.Weld KJ, Dmochowski RR. Effect of bladder management on urological complications in spinal cord injured patients. J Urol 2000;163:768-72.  Back to cited text no. 1
2.Foster H, Ritchey M, Bloom D. Adventitious knots in urethral catheters: Report of 5 cases. J Urol 1992;148:1496-8.  Back to cited text no. 2
3.Kanengiser S, Juster F, Kogan S, Ruddy R. Knotting of a bladder catheter. Pediatr Emerg Care 1989;5:37-9.  Back to cited text no. 3
4.Pearson-Shaver AL, Anderson MH. Urethral catheter knots. Pediatrics 1990;85:852-4.  Back to cited text no. 4
5.Shah PN, Desai R, Macho B. Management of a knotted infant feeding tube in the urinary bladder. Internet J Urol 2005;2:2.  Back to cited text no. 5
6.Carlson D, Mowery BD. Standards to prevent complications of urinary catheterization in children: Should and should-knots. J Soc Pediatr Nurs 1997;2:37-41.  Back to cited text no. 6


  [Figure 1], [Figure 2]

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