Multiorgan failure 17 years after initial stone therapy: forgotten ureteral stent in a horseshoe kidney

We report on the case of a 44-yr-old white man who was referred as an emergency from a local hospital to the medical intensive care unit (ICU) at our institution for progressive multiorgan failure of unknown cause. The CT scan of the abdomen showed a horseshoe kidney with extensive stone formation in both kidneys and the urinary bladder. A massively calcified double pigtail ureteral stent could also be seen in the left upper urinary tract. The stent had been placed prior to extracorporeal shock wave lithotripsy (ESWL) therapy 17 years previously. Three weeks later, after conservative treatment for heart failure and septic complications, the massively enlarged hydronephrotic left part of the horseshoe kidney was exposed and heminephroureterectomy was performed. Moreover, a right-sided pyelotomy was performed. Midline vesicotomy allowed extraction of the remaining bladder stone including the rest of the forgotten pigtail stent. The patient recovered rapidly after surgery and was discharged after 2 wk with all drains removed.