Forgotten DJ stent presenting with emphysematous pyelonephritis: A life threatening complication

Management of forgotten double J stents: insight from a systematic review of case reports

BACKGROUND

Double J Stent is one of the procedures frequently performed in the field of urology. Forgotten DJ Stent is a problem that can cause serious complications. This systematic review aims to explore complications and management of patients with forgotten double J stents.

METHODS

Scientific literature was obtained from PubMed, ScienceDirect, and Google Scholar with a publication year limited to 2013-2023. The search string included 'forgotten DJ stent, case report, complication'. Inclusion criteria were as follows: (1) case report or series, (2) available individual patient data, and (3) English language. Data are presented descriptively.

RESULTS

Of the 210 records, 14 articles published were analyzed after the full-text assessment. Forgotten DJ stent sufferers vary from age 7 years to 88 years. Male gender was predominant. The initial symptoms were flank pain and micturition disorders. The complications experienced were encrustation, multiple stones formation, emphysematous pyelonephritis, emphysematous perinephric abscess, fragmentation, and vesical calculus. In management, it was found that procedures were selected according to patient's situation at that time and the condition of the stent. There are case reports that report management that differed from those initially planned. All the patients were alive after treatment.

CONCLUSIONS

A forgotten DJ stent can have serious consequences. The management approach requires a combination of various endourological procedures. In consideration of potential complications, urologists need to be careful in making decisions about the choice of technique used.

A forgotten double-J ureteral stent resulting in an emphysematous perinephric abscess: A case report

RATIONALE

Double-J stents (DJSs) are urologic devices widely used for urinary tract obstruction treatment. Perinephric abscess is a condition with purulent accumulation resulting from urinary tract infection retained between the renal capsule and Gerota's fascia. Emphysematous urinary tract infection in patients with a forgotten DJS is extremely rare. Herein, we report a case of emphysematous perinephric abscess as a complication in a 56-year-old non-diabetic woman who neglected a 10-year-old DJS placed for obstructive uropathy treatment.

PATIENT CONCERNS

The patient presented with fever and abdominal pain that persisted for 4 days. Laboratory examinations showed leukocytosis, hypoalbuminemia (2.3 g/dL), and elevated C-reactive protein level (305.5 mg/L) with no azotemia.

DIAGNOSIS

Abdominal computed tomography scan revealed a DJS with encrustation and multiple stones in the right kidney as well as a perinephric abscess with gas formation.

INTERVENTIONS

Intravenous administration of piperacillin/tazobactam was initiated immediately and percutaneous catheter drainage was performed. Extended-spectrum beta-lactamase-producing Escherichia coli was identified on abscess culture and antibiotics were switched to meropenem, resulting in gradual improvement of the inflammatory lesion. The patient was referred to the urology department for retained DJS removal and vesicolitholapaxy. A piece of fractured stent was removed via open ureterolithotomy.

OUTCOMES

Since discharge on hospital day 42, she has been under regular follow-up, and the surgical wound has been healing with no significant sequelae.

LESSONS

Prompt medical therapy for inflammation and thorough urologic correction of the stent-induced structural deformities are crucial in long-term neglected DJS and resulting emphysematous perinephric abscess. Patients who undergo DJS placement should be systematically followed up to prevent potential neglect of device management.