Complete intraperitoneal displacement of a double J stent: a first case

Distal end of a ureteral double-J stent displaced into the contralateral ureter after percutaneous nephrolithotripsy: a case report

We report displacement of the distal end of a ureteral double-J stent into the contralateral ureter after percutaneous nephrolithotripsy (PCNL) in a 71-year-old man with a history of left kidney stones. Postoperative computed tomography imaging showed that the distal end of the left ureteral double-J stent was displaced into the right ureter, which resulted in persistent right renal colic when the nephrostomy tube was clipped and continuous urine leakage from the nephrostomy opening after the nephrostomy tube was removed. After the cystoscopic adjustment of the ureteral stent, the patient recovered uneventfully and was discharged home the next day.

Jejunal perforation and upward migration of double J stents during the cystoscopic procedure: a case report and review of literature

While double J (DJ) stenting is common worldwide in the urological procedure, it may associate with severe and catastrophic complications. Penetration of the jejunum and upward migration of double J (DJ) stents during cystoscopic DJ stent procedure are rare complications with few reported cases in the literature. We present a 65-year-old male presented with acute renal failure and peritonitis one week after failed cystoscopic removal of DJ stents. Radiographic investigations showed upward migration of the right DJ stent and a total displacement of the left DJ stent to the peritoneal cavity with peritonitis, bladder perforation, and jejunal injuries. The right DJ stent was removed via the ureteroscopic procedure. Then, open abdominal surgery was performed to remove the left DJ stent and repair the injured bladder wall and jejunal segment. In conclusion, synchronous upward DJ stent migration and peritoneal DJ stent malposition with jejunal and bladder injuries are rare and severe complications of the cystoscopic DJ stent procedure. The treatment should be performed depending on the time of diagnosis, nature of the injury, and general clinical conditions of the patient.

Peritoneal perforation and peritonitis after antegrade double-J stent insertion: A case report and review of the literature

Penetration of peritoneal cavity during antegrade double‐J (DJ) stenting is rare. A 52‐year‐old woman presented with signs of peritonitis for 3 days after left PCNL. Abdominal CT scan revealed a perforation of the peritoneum by the distal coil of DJ stent, which was reinserted into the bladder by ureteroscopy.

Embedded upper end of double J stent at the site of renal pelvis injury following percutaneous nephrolithotomy: a rare complication

Background

Injury of the renal collecting system is a well-known complication of percutaneous nephrolithotomy (PNL). Large injuries may cause excessive bleeding and fluid extravasation and require adequate drainage using several modalities such placement of JJ stents. Herein, we report on two cases in which the upper coil of the JJ stent got buried in the fibrous tissues which formed due to an injury of the collecting system during PNL.

Case presentation

40 years old male and 32 years old female underwent standard PNL for partial and total staghorn calculi, respectively. During the procedure in both cases, the renal pelvis was injured. In both cases, JJ stent was used to drain the collecting system. Trial to remove the JJ stent 6 weeks following the procedure failed because the upper coils of the stents were embedded in the fibrous tissues at the perforation site. Laser incision of the fibrous tissues and releasing the upper coil of the stents were performed using percutaneous approach in the first case and flexible ureterorenoscopy (fURS) in the second patient. The procedures were uneventful in both cases.

Conclusion

This is the first report of embedded JJ stents which got buried by fibrous tissues at the site of collecting system injury that occurred during PNL. To prevent this complication in such cases, we suggest draining the collecting system using nephrostomy tube instead of JJ stent. Alternatively, the upper coil of the stent should be placed away from the injury site.

Wandering Double-J Stent in the Retroperitoneum: A Case Report

Background: Double-J (DJ) stent is an integral part of urologic practice. DJ stents can have numerous complications such as persistent irritative symptoms, encrustations, and up and down migrations within the pelvicaliceal system (PCS), but displacement outside the urinary tract is rare. We are presenting a unique case of DJ stent lying outside the PCS for more than a decade.

Case Presentation: A 46-year-old female presented with left flank pain and dysuria. She had undergone percutaneous nephrolithotomy in the left side 11 years ago. Imaging studies revealed a forgotten DJ stent with proximal part lying in the PCS with dense encrustations and the distal coil in the retroperitoneum at the level of the contralateral sacroiliac joint with the shaft crossing the midline at fourth lumbar vertebral level. The malpositioned forgotten stent was removed intact using the multimodal endourologic technique. During follow-up, the patient had prompt relief of symptoms and a preserved renal unit.

Conclusion: To the best of our knowledge, this is the first report of malpositioned and forgotten DJ stent for more than a decade with lower end lying near the opposite lower ureter managed effectively by an endourologic method.