Hasani Nasibeh, Afyouni Amir, Haddadi Ahmadreza
Department of Gynecology, Shariati Hospital, Esfahan, Iran.
Department of Urology, Shariati Hospital, Esfahan, Iran.
J Med Case Rep. 2025 May 19;19(1):236. doi: 10.1186/s13256-025-05277-0.
Double-J stent placement is a common and generally safe procedure in urology. However, rare complications such as stent misplacement into vascular structures can occur, posing significant risks. The case presented herein highlights an exceedingly rare complication of stent misplacement into the inferior vena cava during the management of a vesicovaginal fistula, emphasizing the importance of prompt recognition and multidisciplinary intervention.
In February 2023, a 48-year-old Iranian woman with history of total abdominal hysterectomy presented with complaints of watery vaginal discharge 1 month postoperatively. She was diagnosed with a vesicovaginal fistula and underwent cystoscopy, ureteroscopy, and attempted placement of a double-J stent. Intraoperatively, the stent was found to be misplaced in the suprarenal segment of the inferior vena cava, near the right atrium, as confirmed by postoperative imaging. The patient subsequently underwent laparotomy for stent removal and ureteral reimplantation. A multidisciplinary surgical team, including vascular surgeons, participated in the procedure to mitigate potential complications. The stent was successfully removed via ureteroscopy without complications, and the ureter was reconnected to the bladder. The patient was followed up for 3 months after stent removal. She remained asymptomatic, with no recurrence of urinary leakage, ureteral obstruction, or thrombotic complications. Follow-up imaging confirmed proper ureteral healing and the absence of any further stent migration. At the final follow-up, the patient reported full recovery with no discomfort or residual symptoms. Written informed consent for publication of this case and accompanying images was obtained from both the patient and the hospital's ethics committee.
This case demonstrates the need for vigilance during stent placement, particularly in patients with altered anatomy. It also underscores the value of timely imaging to identify complications and the importance of a multidisciplinary surgical approach in ensuring successful outcomes. The report contributes to the literature on managing rare urological complications and highlights the role of advanced endoscopic and surgical techniques.
双J管置入术是泌尿外科常见且通常安全的操作。然而，可能会出现罕见并发症，如支架误置入血管结构，带来重大风险。本文介绍的病例突出了在膀胱阴道瘘治疗过程中支架误置入下腔静脉这一极其罕见的并发症，强调了及时识别和多学科干预的重要性。
2023年2月，一名有全腹子宫切除术史的48岁伊朗女性术后1个月出现水样阴道分泌物。她被诊断为膀胱阴道瘘，并接受了膀胱镜检查、输尿管镜检查及双J管置入尝试。术中发现支架误置入下腔静脉肾上腺段，靠近右心房，术后影像学检查证实。患者随后接受剖腹手术取出支架并进行输尿管再植术。包括血管外科医生在内的多学科手术团队参与了该手术以减轻潜在并发症。通过输尿管镜成功取出支架，无并发症，输尿管重新连接至膀胱。支架取出后对患者进行了3个月的随访。她仍无症状，无尿漏、输尿管梗阻或血栓形成并发症复发。随访影像学检查证实输尿管愈合良好，无进一步支架移位。在最后一次随访时，患者报告完全康复，无不适或残留症状。已获得患者和医院伦理委员会对发表该病例及相关图像的书面知情同意。
本病例表明在支架置入过程中需要保持警惕，尤其是在解剖结构改变的患者中。它还强调了及时成像以识别并发症以及多学科手术方法在确保成功结果方面的重要性。该报告为管理罕见泌尿外科并发症的文献做出了贡献，并突出了先进内镜和手术技术的作用。
