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

Abstract

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.

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“…The best method for locating perinephric abscesses is computed tomography (CT) with contrast since it can both locate and quantify the abscess. Additionally, perinephric suppuration to nearby tissues such the liver, mediastinum, and diaphragm can be evaluated using enhanced CT. 7 Antimicrobial medications combined with PCD are advised as the Àrst line of therapy for a big perinephric abscess (>3 cm), as the abscess may spread to other nearby retroperitoneal organs as well as the perinephric space. However, surgical procedures should be seriously considered if medicinal treatment is ineffective for treating the abscess.…”