經皮腎造廔碎石術後雙J導管錯位及輸尿管穿孔：罕見併發症病例報告

康庭碩、王百孚、林介山、張進寶、嚴孟意、黃勝賢、陳俊吉、張建祥、
陳柏華、陳一中、潘岳、石宏仁

彰化基督教醫院泌尿外科

Ureteral perforation with double-J stent malposition after percutaneous nephrolithotomy (PCNL): a rare complication case report

Ting-Shuo Kang, Pai-Fu Wang, Jesun Lin, Chang-Pao Chang, Meng-Yi Yan, Sheng-Hsien Huang, Chun-Chi Chen, Jian-Xiang Zhang, Pao-Hwa Chen, Yi-Zhong Chen, Pan Yueh, Hung-Jen Shih

Division of Urology, Department of Surgery, Changhua Christian Hospital

Introduction:

Double J stents are commonly employed in endourological procedures to manage obstructed ureters or following ureteral interventions. Despite the standardization of the stent placement procedure and the accumulation of substantial experience, the occurrence of stent malpositioning outside the ureter is still a potential concern. In this case presentation, we describe a patient who presented with lower abdominal pain after the percutaneous nephrolithotomy (PCNL) with antegrade Double-J stent insertion.

Case description:

  A 66-year-old female patient presented with right flank pain for one month. A kidney-ureter-bladder (KUB) X-ray revealed right renal stones. Following a discussion of treatment options with the patient, PCNL with antegrade insertion of a Double-J stent were performed. The intraoperative X-ray image confirmed the proper positioning of the Double-J stent. However, the patient continued to experience persistent lower abdominal pain and poor response to medical treatment. Follow up KUB X-ray showed the position of DJ stent outside the bladder shadow. Malposition of the Double-J stent was suspected. Subsequent abdominal computed tomography (CT) confirmed the malposition of the Double-J stent, with penetration into the upper ureter and fluid collection in the pelvic area. Consequently, a ureteroscopy was performed to remove the malpositioned stent using forceps, and a new stent was inserted. Following the procedure, the patient was discharged without any complications.

Conclusion:

Malposition of DJ stent should be kept in mind when patient present with persistent abdominal pain and poor response to medical treatment. Clinicians should pay attention to the early identification and treatment of this complication.