Metachronous renal vein and artery injure after percutaneous nephrostolithotomy

BACKGROUND Percutaneous nephrostolithotomy is important approach for kidney stones removal. A percutaneous nephrostomy drainage tube placement is an effective method to stop venous bleeding. Occasionally, the catheter can pierce into the renal parenchyma, and migrate into the renal vein even to the vena cava. CASE PRESENTATION A 66-year-old woman underwent a percutaneous nephrostolithotomy for kidney staghorn stone complicating severe bleeding. A computed tomography angiography showed the percutaneous nephrostomy drainage tube inside the renal vein. The percutaneous nephrostomy drainage tube was withdrawn 3 cm back to the renal parenchyma/sinus/pelvis in stages with the surgical team on standby. Seven days later, the patient developed severe hematuria. Computed tomography angiography demonstrated the pseudoaneurysm located near the percutaneous nephrostomy drainage tube. Pseudoaneurysm is embolized successfully. CONCLUSION Our case shows intravenous misplacement of the nephrostomy tube and subsequent pseudoaneurysm after percutaneous nephrostolithotomy. To our knowledge, this seems to be the first documentation of major bleeding from the injury to both renal vein and artery. The percutaneous nephrostomy drainage tube can be withdrawn back to the renal parenchyma/sinus/pelvis in stages with the surgical team on standby, and the withdrawn distance may vary according to patient and catheter position.