Kumar Prashant, Nayyar Rishi
Department of Urology, AIIMS, New Delhi, New Delhi, India.
J Endourol Case Rep. 2017 Sep 1;3(1):123-125. doi: 10.1089/cren.2017.0067. eCollection 2017.
Drainage of any deep seated abscess often requires placement of catheters along with other conservative measures. These catheters are removed when the drainage volume reduces to clinically insignificant levels. However, if left , there are potential complications. One such complication necessitating additional surgical procedure is highlighted in this case report. Malecot's catheter and children may be more at risk for such a complication. A 7-year-old girl presented with recurrent episodes of right flank pain associated with high-grade fever with chills for the last 5 months and right perinephric drain . She had earlier presented at an outside center and was found to have bilateral renal calculi and left lower ureteral calculi along with right perinephric abscess and pyonephrosis. She underwent right perinephric drain and bilateral Double J (DJ) placement 4 months ago. The perinephric drain initially drained around 250 mL pus each day and progressively ceased to drain by 15-20 days. However, the drain was left and the girl was referred for management of bilateral renal and left ureteral calculi. Pending her consultation, the drain and stents remained forgotten. At presentation, blood urea and serum creatinine were 20 and 0.2 mg%, respectively. Urine culture was sterile. Non-contrast computerized tomography kidney, ureter, and bladder radiograph showed right perinephric drain, bilateral DJ stents with bilateral renal (lower and middle caliceal) calculi, and a chain of left upper ureteral calculi. A small loculated subcapsular collection was also noted at the lower pole of right kidney. All efforts made to pull out the drain under local anesthesia were in vain. The drain was found to be impacted and could not be taken out. Decision was taken to remove the drain laparoscopically. Drain was removed effectively and B/l DJ stents were changed followed by staged procedure for calculi. Malecot catheters may be more prone to ingrowth of tissue because of their inherent design of wider holes, all located at the tip of the catheter. This unique case emphasizes the need for careful follow-up of a patient with perinephric drain and difficulties with the removal of a Malecot catheter compared with a pigtail catheter, particularly in children. Laparoscopic removal of retained Malecot catheter as perinephric drain is a safe option of treatment in such a case.
任何深部脓肿的引流通常都需要放置导管并采取其他保守措施。当引流量减少到临床上无显著意义的水平时，这些导管即可拔除。然而，如果导管留置，就会有潜在的并发症。本病例报告突出了一种需要额外手术的并发症。马勒科特导管（Malecot's catheter）在儿童中可能更容易出现这种并发症。一名7岁女孩在过去5个月里反复出现右侧胁腹疼痛，并伴有高热寒战，同时还有右侧肾周引流管。她早些时候在外部医疗机构就诊，被发现患有双侧肾结石、左输尿管下段结石，以及右侧肾周脓肿和肾盂积脓。4个月前，她接受了右侧肾周引流和双侧双J管（DJ管）置入术。肾周引流管最初每天引流约250毫升脓液，到15 - 20天时逐渐停止引流。然而，引流管被留置，该女孩被转诊以处理双侧肾脏和左输尿管结石。在等待会诊期间，引流管和支架被遗忘。就诊时，血尿素和血清肌酐分别为20和0.2毫克%。尿培养无菌。非增强CT肾脏、输尿管和膀胱造影显示右侧肾周引流管、双侧DJ支架以及双侧肾脏（下盏和中盏）结石，还有左输尿管上段结石链。在右肾下极还发现一个小的局限性包膜下积液。在局部麻醉下试图拔出引流管的所有努力均告失败；发现引流管受阻无法拔出。决定通过腹腔镜取出引流管。引流管被有效取出，双侧DJ支架更换，随后分期进行结石手术。由于马勒科特导管本身的设计特点是其较宽的孔都位于导管尖端，所以可能更容易出现组织向内生长的情况。这个独特的病例强调了对于有肾周引流管的患者需要仔细随访，并且与猪尾导管相比，拔除马勒科特导管存在困难，尤其是在儿童中。在这种情况下，腹腔镜下取出作为肾周引流管的留置马勒科特导管是一种安全的治疗选择。
