Accidental insertion of double-J in the inferior vena cava in a patient with retroperitoneal fibrosis: a case report

Abstract

Background Implantation of the double-J stent is a common procedure in urology. The function of this device is to maintain the flow of urine from the ureteropelvic junction to the urinary bladder when the ureter is blocked or partially blocked for some reason. Once in place, the stent may cause low back pain, hematuria, symptoms of urinary irritation, a reduction in labor capacity, infection and calcification which are side effects that are easy to manage. However, severe complications can occur, such as the insertion of the stent into the circulatory system, such as the vena cava, which, although uncommon, is one of the most severe and difficult to manage. This work reports the case of a patient with the accidental insertion of a double-J stent into the inferior vena cava. Case Description An 80-year-old female patient with repeated urinary tract infections using a double-J stent due to stenosis of the right distal ureter distal presenting retroperitoneal fibrosis secondary to previous radiotherapy. The patient had Lynch syndrome, ovarian and uterine cancer, colorectal cancer, and nephrolithiasis. She had been submitted to multiple previous surgeries. Due to the possibility of viral infection by coronavirus disease 2019 (COVID-19), chest computed tomography was performed, which suggested the insertion of the double-J stent in the inferior vena cava, confirmed by abdominal computed tomography. As the distal end of the stent was within the bladder, the decision was made to remove the stent by cystoscopy, with the implantation of a new stent using fluoroscopic control for the confirmation of its trajectory. No intraoperative or postoperative complications occurred and the patient is currently in outpatient follow-up. Conclusions Situations such as this require caution during the implantation of the drainage device, with the occurrence of resistance indicating the need to discontinue the procedure and perform a new assessment with imaging exams. No intraoperative or postoperative complications occurred and the patient is currently in outpatient follow-up.