Delayed Migration of Embolized Coil with Large Renal Stone Formation: A Rare Presentation

Abstract

Delayed bleeding following percutaneous nephrolithotomy (PCNL) usually occurs due to development of the pseudoaneurysm which can be successfully managed with coil embolization. However very few cases of such complications have been reported in the literature. Here we are reporting a case of delayed post-PCNL bleeding that occurred in a 53-year-old diabetic patient operated on for renal stone. Computed tomography scan revealed a presence of the pseudoaneurysm in the segmental branch of right renal artery, which was successfully managed with coiling. Patient remained asymptomatic for the next 9 years after which he again presented with similar complaints. X-ray KUB was done which revealed a 2.7 cms renal pelvic calculus with the migrated coil in its center and a left upper ureteric calculus. His routine haemogram, coagulogram, serum electrolytes, and liver function tests, renal function tests, vitamin D3, and PTH (parathyroid hormone) were within normal limits. He underwent left laparoscopic ureterolithotomy and right percutaneous nephrolithotomy (PCNL). Intraoperatively the migrated stainless steel embolization coil was seen engulfed all around by the multiple stones in the right renal pelvis. Postoperative period was uneventful. Later he was followed in the outpatient department and was doing well. To conclude, this is the only case report of development of a large calculus around a migrated embolization coil which was successfully managed with PCNL. PCNL offers better stone clearance in cases of stones being formed over foreign bodies like fragmented double J stents, fragmented nephrostomies, or migrated embolization coil.

Immediate and delayed migration of Onyx embolisation into the renal collecting system

“…Some passed spontaneously 6 7. Others required ureteroscopy or percutaneous nephrolithotomy for removal 8–12. The only other reported case of Onyx embolisation into the collecting system is described by Ierardi et al .…”

“…Potential complications include renal artery dissection, postembolisation syndrome (self-limited flank pain, nausea and vomiting), diminished renal function, groin haematoma and migration of embolisation material 3–5. There are a few examples of embolisation coils eroding into the collecting system and only one reported case of this occurring with Onyx 6–13. We present a case of recurrent Onyx migration into the renal collecting system requiring ureteroscopic removal.…”

Massive migration of embolization coils inside the renal pelvis. A rare complication that can be approached through percutaneous surgery

“…Embolization coil migration is a very rare complication reported in <2% of cases. The migration of coils in the collecting system is extremely rare, with only a few cases reported [1–5].…”

“…A stone formed around a wire coil was treated by ureteroscopy via pneumatic lithotripsy and grasps. Other reports are by Poyet et al [4] and Kumar et al [5]. The first one used a retrograde intrarenal approach to fragment the stone by holmium laser energy, and to extract the coil.…”

Interventional Radiology-Operated Endoscopy: Indications, Implementation, and Innovation

“…Though rare, migrated renal embolization coils have also been retrieved. [14][15][16][17] The removal of migrated coils has a high risk of causing significant bleeding and interventional radiologists may be prepared to treat such complications with simultaneous prone transradial arterial access. 18…”