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Neurological Rehabilitation

Overdistended Suprapubic Catheter Balloon as a Nidus for Autonomic Dysreflexia: A Case Report

Saturday, October 25, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 5

    Poster Presenter(s)

  • Elizabeth Chang, MD

    Resident Physician
    Schwab Rehabilitation Hospital & Care Network/University of Chicago PM&R Program
    Chicago, Illinois

    • Co-Author(s)

  • Steven Le, MD

    Resident Physician
    Schwab Rehabilitation Hospital & Care Network/University of Chicago PM&R Program
    Chicago, Illinois

  • RL

    Raymond Lee, MD

    attending physician
    Schwab Rehabilitation Hospital & Care Network/University of Chicago PM&R Program
    Chicago, Illinois

Disclosure(s):
Elizabeth Chang, MD: No financial relationships to disclose
Steven Le, MD: No financial relationships to disclose
Case Diagnosis: 23-year-old male ​with C4 ASIA A complete paraplegia secondary to a diving accident

Case Description or Program Description: Patient presented with systolic blood pressure elevated to the 120s, tachycardia reaching the 130s, and associated lightheadedness, consistent with his prior episodes of autonomic dysreflexia (AD). A bladder scan revealed 59mL of urine. Patient’s suprapubic catheter (SPC) had been exchanged two days prior and was draining appropriately. The SPC port was flushed daily with 10mL of water to maintain patency. Upon aspiration, over 30mL of fluid was removed from the SPC balloon port. The SPC was removed, and after replacement with a new 16 French SPC, the patient's vital signs improved, with resolution of AD noted.

Setting: Acute inpatient rehabilitation

Assessment/Results: Common etiologies of AD, including constipation, tight clothing, and skin breakdown, were ruled out. Examination of the discontinued SPC revealed that the balloon was intact. However, the SPC balloon was easily distensible to a maximum capacity of 55mL before balloon failure, despite requiring only 10mL for adequate inflation and proper placement. It was noted that attempted irrigation of the SPC was likely occurring in the balloon port in error.

Discussion (relevance): Inappropriate SPC balloon inflation should be considered during systematic evaluation of potential causes of AD in spinal cord injury (SCI) patients using SPCs for bladder management. Instances of balloon overdistension may go unnoticed, especially if the balloon inflates without resistance. Nevertheless, overdistension may serve as a mechanical irritant and lead to AD.

Conclusions: While previous reports have highlighted inappropriate SPC balloon placement as a trigger for AD, this is likely the first case in which an overdistended SPC balloon was identified as the etiology. In SCI patients with SPCs who experience AD, besides common urologic triggers including bladder distention, UTIs, and catheter kinking, the placement and status of the SPC balloon should be thoroughly evaluated to prevent potential AD.