Incidental misplacement of a percutaneous nephrostomy tube in the inferior vena cava

Abstract

Introduction: Misplacement of a percutaneous nephrostomy tube during the treatment of isolated renal pelvis rupture in a patient with pre-existing hydronephrosis caused by postirradiation ureteral stricture is presented. Case report: A 36-year-old woman was referred to our institution by her gynaecologist for the treatment of a retroperitoneal urinoma. She had completed irradiation treatment with concurrent cisplatinum chemotherapy for a uterine malignancy one year ago. A computed tomography scan showed an isolated rupture of the left renal pelvis with pre-existing hydronephrosis. A nephrostomy catheter was misplaced in the inferior vena cava during the percutaneous urinary drainage attempt. The patient underwent a laparotomy, renal pelvis suture and ureteroneocystostomy with an indwelling double pigtail stent. The percutaneous nephrostomy was removed during the same surgical procedure. Conclusion: Inadvertent injury of vascular structures is a possible complication of percutaneous nephrostomy under ultrasound guidance. It may have been possible to avoid the reported complication if the dilation of the nephrostomy tract over the guidewire had been performed under contrast-enhanced X-ray fluoroscopy. Key words: nephrostomy tube, renal pelvis injury, vena cava injury. Apstrakt Uvod: Prikazan je neadekvatan plasman nefrostomskog katetera prilikom tretmana izolovane rupture pijelokaliksnog sistema kod bolesnice sa pre-egzistentnom hidronefrozom izazvanom postiradijacionom stenozom uretera. Prikaz slučaja: Pacijentkinja stara 36 godina upućena je u našu instituciju od strane ginekologa radi tretmana retroperitonealnog urinoma. Pre godinu dana završena je kombinovana zračna terapija i primena hemioterapije cisplatinom zbog ginekološkog maligniteta. Kompijuterizovana tomografija je pokazala izlovanu rupturu pijelokaliksnog sistema levog bubrega sa pre-egzistentnom hidronefrozom. Nefrostomski kateter je nehotično plasiran u venu kavu inferior prilikom pokušaja preliminarne perkutane drenaže. Pacijentkinji je uradjena laparotomija, sutura pijelokaliksnog sistema i ureterocistoneostomija sa postavljanjem dvostrukog pigtail katetera. Nefrostomski kateter je uklonjen operativno u toku iste procedure. Zaključak: Incidentalna povreda vaskularnih struktura je moguća kod 4 ultrazučno vođenog plasmana nefrostomskog katetera. Moguće je da je navedena komplikacija mogla biti izbegnuta da je dilatacija nefrostomskog trakta preko žice vodilje rađena pod kontrastnom radiološkom fluoroskopijom. Ključne reči: nefrostomski kateter, povreda pijelona, povreda vene kave inferior.