Migration of a double J stent into the inferior vena cava: a
A 53-year-old male patient with a history of long-standing left renal calculi underwent left-side pyelolithotomy with postoperative placement of a DJS at a county hospital on April 2016. However, the stent placement was not performed under fluoroscopy guidance and postoperative imaging examinations were not performed to confirm the DJS position. The patient was advised for stent removal after 5 months. Surprisingly, kidney, ureters, and bladder (KUB) x-ray film showed that the DJS was not in the right location and appeared to enter into the IVC.

For further managements, the patient was transferred to our hospital. During hospitalization, moderate flank pain persisted. Blood analysis showed normal leukocytes counts and normal creatinine levels. Urine analysis showed increased leukocytes counts and increased erythrocyte counts. Further urine culture was positive with a growth of Enterococcus faecalis. Color Doppler flow imaging (CDFI) showed the formation of small mural thrombus in the IVC. Therefore, the patient was assigned to treatments with anticoagulants and antibiotics. The next-day computed tomography urography (CTU) was performed to assure the position of the stent. In combination of left-side hydronephrosis, migration of the DJS into the IVC was seen at the level of the left renal vein. The proximal coil was in the IVC and the distal coil was in the left renal pelvis.

Then, we performed percutaneous nephroscope under C-arm guidance by using 18G puncture needles and 20 Fr working sheaths. The distal coil of the DJS was visualized and removed successfully under nephroscope without any complications. A new DJS was placed and its location was confirmed by radiologic imaging. After the operation, the patient was transferred to intensive care unit (ICU) and treated with continued anticoagulants and antibiotics. Fifteen days after the operation, CDFI showed there was no thrombus in the IVC. The patient was discharged 16 days after the operation with symptom free and the follow-up was uneventful.

Source: Medicine: May 2019 - Volume 98 - Issue 20 - p e15668

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