Qi Wenqi, Jiang Shou-Yin
Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Zhejiang Key Laboratory of Trauma, Burn, and Medical Rescue, Hangzhou, China.
Front Med (Lausanne). 2025 Apr 30;12:1570823. doi: 10.3389/fmed.2025.1570823. eCollection 2025.
Hematuria, a common clinical indicator of genitourinary tract pathology, arises from diverse etiologies including calculi, infections, malignancies, trauma, and iatrogenic causes. Initial evaluation requires hemodynamic assessment, identification of underlying causes, and urinary drainage optimization. This report highlights a rare case of iatrogenic hematuria secondary to double-J stent migration into the inferior vena cava.
A Chinese male presented with acute left flank pain and gross hematuria persisting for 4 h. Diagnostic imaging revealed a left ureteral stone, prompting double-J stent placement at a local hospital. Despite intervention, hematuria worsened, necessitating abdominal CT. Imaging identified proximal migration of the left double-J stent into the inferior vena cava, with no evidence of vascular injury. Due to concerns regarding inadequate drainage and infection risk, conservative management without catheter clamping was initiated prior to referral. Definitive treatment involved ureteroscopic stent removal under direct visualization at our institution, resulting in rapid symptom resolution.
This case emphasizes three critical clinical insights: (1) Persistent postoperative hematuria warrants consideration of iatrogenic causes, particularly following urologic device placement. (2) Imaging modalities, especially CT, are indispensable for detecting atypical stent migration. (3) Comprehensive history-taking must include prior urologic interventions to guide differential diagnosis. While double-J stent migration into major vessels remains exceptionally rare, its recognition prevents delayed management of potentially life-threatening complications. Clinicians should maintain heightened vigilance for device-related hematuria in patients with refractory symptoms post-procedurally, ensuring prompt imaging evaluation and multidisciplinary intervention when indicated.
血尿是泌尿生殖道疾病常见的临床指标，其病因多样，包括结石、感染、恶性肿瘤、创伤和医源性原因。初始评估需要进行血流动力学评估、确定潜在病因并优化尿液引流。本报告重点介绍了一例罕见的医源性血尿病例，该病例由双J支架迁移至下腔静脉引起。
一名中国男性因急性左侧腰痛和肉眼血尿持续4小时就诊。诊断性影像学检查发现左侧输尿管结石，促使当地医院放置双J支架。尽管进行了干预，但血尿仍加重，因此需要进行腹部CT检查。影像学检查发现左侧双J支架近端迁移至下腔静脉，未发现血管损伤迹象。由于担心引流不足和感染风险，在转诊前开始了不夹闭导管的保守治疗。最终治疗是在我们机构直接可视化下通过输尿管镜取出支架，症状迅速缓解。
该病例强调了三个关键的临床要点：（1）术后持续血尿需要考虑医源性原因，特别是在放置泌尿外科器械后。（2）影像学检查方法，尤其是CT，对于检测非典型支架迁移必不可少。（3）全面的病史采集必须包括既往的泌尿外科干预措施，以指导鉴别诊断。虽然双J支架迁移至大血管仍然极为罕见，但认识到这一点可防止对潜在危及生命的并发症的延迟处理。临床医生应对术后出现难治性症状的患者的器械相关血尿保持高度警惕，确保在需要时及时进行影像学评估和多学科干预。
