Abstract
Clinical History:
A 75-year-old female patient with a history of bilateral obstructive uropathy secondary to bilateral radiation-induced ureteric strictures attended for bilateral nephrostomy tube (NT) placement. The patient had a history of endometrial cancer, treated previously by total hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemo-radiotherapy and brachytherapy. Her recovery had been further complicated by the development of radiation cystitis, small bowel resection, and short gut syndrome.
The strictures had previously been managed with bilateral internalized ureteric stents, which have now failed. A left sided NT insertion was performed. A CT-scan prompted by a repeat deterioration in renal function revealed a right sided hydronephrosis and suggested transcolic passage of the previously placed left sided NT.
Physical Exam:
She had remained clinically well and asymptomatic.
Diagnosis:
Despite multidisciplinary input, there remained ambiguity in terms of a definite diagnosis of iatrogenic colonic perforation based on imaging and clinical picture alone. As a primary diagnostic intervention, a colonoscopy was arranged.
Intervention:
The NT was clearly visualized. Endoscopic clips were applied to both the entry and exit point, and the NC completely retracted. A left NT was reinserted after further dilatation of the left cavities. The patient developed a pseudoaneurysm discovered following hematuria on day 1 postoperatively which was managed with a super-selective embolization.
Follow-Up/Outcomes:
The patient was finally discharged with clear urine and good renal function on day 5. She therefore presented with two major complications of NT placement in a single case: colonic perforation and pseudoaneurysm, treated with minimally invasive management.
Conflicts of interest:
O.T. has declared as consultant for Karl Storz, Coloplast, IPG photonics, Ambu, Quanta System and Rocamed. All other authors have no conflicts of interest.
The patient has given her permission for her file to be presented.
Runtime of video: 6 min 54 sec.
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