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BACKGROUND Septic shock is highly prevalent in clinical practice. Some cases present insidiously and have poor prognoses. We report a case of a patient with a dislodged catheter who developed septic shock during a cystostomy procedure. CASE REPORT Our patient was a 76-year-old man with a history of hypertension, type 2 diabetes mellitus, and cerebral infarction. He had been confined to bed for a long time following a cerebral infarction and had impaired consciousness. One year prior, he developed urinary retention due to benign prostatic hyperplasia. As he did not undergo surgical treatment, a long-term indwelling urinary catheter was subsequently placed. He initially presented to the emergency department of our hospital at 8: 30 PM on November 1, 2025, 8 hours after accidental urethral catheter dislodgement. A cystostomy was recommended, but he refused and left against medical advice. At approximately 8: 00 AM on November 2, 2025, he returned to the hospital and consented to cystostomy. During the procedure, he developed septic shock. Postoperatively, he was transferred to the intensive care unit for further treatment. Three days later, the family decided to discontinue active treatment and took the patient home. Follow-up revealed that the patient died 2 days after discharge. CONCLUSIONS This case highlights the critical importance of early infection screening and prompt sepsis recognition prior to surgical procedures in elderly, frail, and catheter-dependent patients. It also highlights the importance of keeping the catheter unobstructed and ensuring proper home care.