Ureterovaginal fistula after hysterectomy with double-J stent misplacement into the inferior vena cava: a case report.

Abstract

Background: 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.

Case presentation: 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.

Conclusion: 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.