Patient: Male, 39-year-old
Final Diagnosis: Fragmented ureteric stent
Symptoms: Lumbar pain
Medication:—
Clinical Procedure: Laser lithotripsy • ureteroscopy
Specialty: Urology
Objective:
Unusual clinical course
Background:
Encrustation of the ureteral stent is a common complication that occurs after a prolonged indwelling duration. Other identified risk factors in the literature include urinary sepsis, chemotherapy, chronic renal failure, metabolic or congenital abnormalities, and nephrolithiasis. This report presents the case of a 39-year-old man with nephrolithiasis and fragmentation of a calcified right ureteric stent that required ureteroscopy and laser lithotripsy.
Case Report:
A 39-year-old man was initially admitted for ureteroscopy and laser lithotripsy after the diagnosis of bilateral urolithiasis. Ureteral stents were placed. One postoperative month later, the patient returned for follow-up and stent withdrawal. Follow-up computed tomography revealed a normal left kidney, intact bilateral ureteral stents, and residual right renal stones. However, an attempt to completely withdraw the stent failed and the patient had to undergo a secondary right ureteroscopy with laser lithotripsy. The fragmented proximal section of a calcified right ureteral stent with occluded lumen was found intraoperatively and sent for product analyses. After successful reintervention, the patient had a new right ureteral stent placed, which was successfully withdrawn during his next follow-up.
Conclusions:
Ureteral stent encrustation may occur earlier than anticipated, possibly due to underlying patient risk factors. Complications, such as fragmentation of the ureteral stent, may occur during withdrawal. Physicians should be aware of any predictors for early ureteral stent encrustation to prevent unnecessary reintervention.
Spontaneous rupture of the iliac vein is a rare cause of retroperitoneal hematoma. A misdiagnosis may delay the treatment and consequently put the patient in a life-threatening emergency. We report the case of a 73-year-old woman who presented with hemorrhagic shock from bleeding caused by a large left retroperitoneal hematoma. She was successfully treated with an endovascular approach by using a double bare stent technique. An extensive review of the literature was conducted and a total 44 articles with 50 patients were identified. Among these patients, 88.2% were women, 94.1% presented with a left-sided rupture, and the mortality rate was 13.7%. Spontaneous iliac vein rupture was more likely to occur in the left side in female patients. Conservative treatment was an option in hemodynamically stable patients. Exploratory laparotomy and surgical iliac vein repair was necessitated in most patients. Endovascular treatment including placement of covered stent and coil embolization had been widely used to treat spontaneous vein rupture since 2003. Double bare stent technique was also an effective alternative if a suitable covered stent was unavailable.
We report an unusual case of a 40-year-old male patient who experienced painful swelling of the left lower limb that persisted for 1 week. Imaging modalities not only confirmed the diagnosis of acute iliofemoral venous thrombosis and pulmonary embolism (PE), but also an incidental finding of interrupted inferior vena cava (IVC). This congenital anomaly is uncommon but rarely associated with venous thromboembolism (VTE). The azygos continuation was compressed by the descending aorta against the 11th thoracic vertebrae, which was identified as the cause of VTE. He was treated successfully with anticoagulation and compression therapy. The patient was discharged with lifelong oral Rivaroxaban and remained asymptomatic. In the literature, only 9 cases of interrupted IVC-associated PE were identified but none was due to significant venous compression.
Challenging differential diagnosis Background:Percutaneous nephrolithotomy (PCNL) is indicated for large renal calculi (³2 cm) and is often the treatment of choice due to its high success rate. Guidewire fragmentation is a rare procedural accident that can occur in PCNL but may be missed. Retention of the fragment within the upper urinary tract can lead to further complications, such as recurrent nephrolithiasis or impairment of renal function.
Case Report:We present the case of a 54-year-old man who experienced right flank pain for 5 days. His history was significant for recurrent nephrolithiasis, managed by PCNL in other hospitals. The most recent procedure was conducted 4 years ago, and his perioperative course was uneventful. Preoperative computed tomography revealed right renal calculi and a C-shaped foreign body. He was scheduled for an elective PCNL. The foreign body was intraoperatively identified as a guidewire fragment and removed.
Conclusions:Currently, there is no standard management for intrarenal foreign bodies. Suspicion should be raised in young patients with recurrent stones within a short period of time. A thorough history on past urological interventions should be obtained. Symptoms can also have an insidious onset that could mimic nephrolithiasis or urinary tract infections. Extraction can be done via a standard minimally invasive approach. It is also the surgeon's responsibility to check the integrity of intraoperative instruments so as to minimize risks of complication and reassure the patient.
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