Plausible mechanism of small bowel injury during trocar cystostomy

An 86-year-old man presented with urinary retention secondary to detrusor failure and bulbar urethral stricture. He had a non-tender, palpable, grossly distended bladder and a very poor tone in the muscles of the abdominal wall. He did not allow urethral or suprapubic catheterisation under local anaesthesia; hence, a trocar cystostomy was performed under a short general anaesthesia, which led to injury to the small bowel when least expected. We discuss its subsequent management and plausible mechanism underlying this unexpected complication in the given circumstances.