A forgotten double-J ureteral stent resulting in an emphysematous perinephric abscess: A case report
In Hee Lee1, Hong Seok Shin2, Dong Jik Ahn3
1Department of Internal Medicine, Daegu, Republic of Korea.
Rationale:
Double-J stents (DJSs) are urologic devices widely used for urinary tract obstruction treatment. Perinephric abscess is a condition with purulent accumulation resulting from urinary tract infection retained between the renal capsule and Gerota's fascia. Emphysematous urinary tract infection in patients with a forgotten DJS is extremely rare. Herein, we report a case of emphysematous perinephric abscess as a complication in a 56-year-old non-diabetic woman who neglected a 10-year-old DJS placed for obstructive uropathy treatment.
Patient Concerns:
The patient presented with fever and abdominal pain that persisted for 4 days. Laboratory examinations showed leukocytosis, hypoalbuminemia (2.3 g/dL), and elevated C-reactive protein level (305.5 mg/L) with no azotemia.
Diagnosis:
Abdominal computed tomography scan revealed a DJS with encrustation and multiple stones in the right kidney as well as a perinephric abscess with gas formation.
Interventions:
Intravenous administration of piperacillin/tazobactam was initiated immediately and percutaneous catheter drainage was performed. Extended-spectrum beta-lactamase-producing Escherichia coli was identified on abscess culture and antibiotics were switched to meropenem, resulting in gradual improvement of the inflammatory lesion. The patient was referred to the urology department for retained DJS removal and vesicolitholapaxy. A piece of fractured stent was removed via open ureterolithotomy.
Outcomes:
Since discharge on hospital day 42, she has been under regular follow-up, and the surgical wound has been healing with no significant sequelae.
Lessons:
Prompt medical therapy for inflammation and thorough urologic correction of the stent-induced structural deformities are crucial in long-term neglected DJS and resulting emphysematous perinephric abscess. Patients who undergo DJS placement should be systematically followed up to prevent potential neglect of device management.
Insights
A forgotten Double-J stent (DJS) caused a rare emphysematous perinephric abscess in a non-diabetic woman. Prompt treatment involving antibiotics, drainage, and stent removal led to recovery.
Area of Science:
- Urology
- Infectious Diseases
- Radiology
Background:
- Double-J stents (DJSs) are common in treating urinary tract obstruction.
- Perinephric abscesses involve pus accumulation between the renal capsule and Gerota's fascia, often due to urinary tract infections.
- Emphysematous urinary tract infections with neglected DJS are exceptionally rare.
Observation:
- A 56-year-old woman presented with fever and abdominal pain after neglecting a DJS for 10 years.
- Laboratory results indicated leukocytosis, hypoalbuminemia, and significantly elevated C-reactive protein.
- CT scans revealed an encrusted DJS, kidney stones, and a perinephric abscess with gas formation.
Findings:
- The patient received intravenous piperacillin/tazobactam, followed by meropenem after identifying Extended-spectrum beta-lactamase-producing Escherichia coli.
- Percutaneous catheter drainage and subsequent open ureterolithotomy were performed to remove the fractured stent.
- The patient showed gradual improvement and was discharged with a healing wound.
Implications:
- Effective management of neglected DJS complications like emphysematous perinephric abscess requires prompt medical and surgical intervention.
- Systematic follow-up of patients with DJS is essential to prevent device neglect and associated severe outcomes.
- This case highlights the importance of patient adherence to medical device management protocols.
Related Concept Videos
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:27Acute Pyelonephritis I: Introduction
01:25Urinary Tract Infection II: Pathophysiology
01:25Urinary Tract Calculi VI: Surgical Management
01:26Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations
01:25Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications