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Balkan

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Balkan

  1. 1. IATROGENİC URETERAL RUPTURE: URETERAL PERFORATION CAUSED BY NEPHROSTOMY CATHETER Ali DADASHOV, Bulent KARAMAN,Aydın ASLAN
  2. 2. • Perforation of the ureter during nephrostomy catheter placement is a rare condition that may cause a series of problems including retroperiteonal urinoma, urosepsis, abscess formation, infection etc. • We report a rare case of ureteric rupture caused by nephrostomy catheter.
  3. 3. • The patient was managed with progressively enlarged nephrostomy catheters with continuation of percutaneous drainage and antibiotics. • The present case illustrates that wrong drection of nephrostomy chatheter in patients with ureteral obstruction for any reason can perforate ureter, which in turn may be treated by continuation of percutaneous drainage avoiding an emergency surgery.
  4. 4. • During nephrostomy catheter placement, ureteral rupture may occur if you point chatheter tip to the wall of the obstructed ureter. • We report a case of ureteral rupture in a patient who had a malfunctioned ureteral stent and bladder tumor.
  5. 5. • A 63-year-old man was admitted to our department with hydronephrosis due to malfunctioned ureteral stent (double-j chatheter). CASE RAPORT
  6. 6. CASE RAPORT • His medical history revealed a bladder tumor with ureteral invasion. After intraducing a amplatz guidewire to renal pelvis it was sent to bladder in paralel to the stent.
  7. 7. CASE RAPORT • After the percutaneous tract dilatation nephrostomy chatheter was sent over the guide wire. • Distal part of catheter was left in the proximal ureter and guide wire was removed.
  8. 8. CASE RAPORT • Pig tail formation of the distal chatheter part was achivied. After wards, contrast material was injected and extravasation from proximal ureter was seen to demonstrate rupture of proximal ureter.
  9. 9. CASE REPORT • One day later patient was called for control and contrast enhanced radiogram was obtained. Extravasation was persistent and for this reason 8F catheter was repliced with 10 F catheter and antibiotherapy was started. BEFORE AFTER
  10. 10. CASE REPORT • Three days later the patient was called back for control.
  11. 11. CASE REPORT • Diminshing extravasation was seen in the control pyelography. This time catheter was replaced with 14 F size. THE FIRST DAY 3 DAYS LATER
  12. 12. CASE REPORT • After a few days patient was called for another control. Spontaneous ureteral healing were verified. THE FIRST DAY 3 DAYS LATER 8 DAYS LATER
  13. 13. CASE REPORT • Spontaneous ureteral healing and working ureteral stents were verified.
  14. 14. RESULT • Eventually ureteral stent obstruction was decided to have developed secondary to infection in the first place,which was then relivied following anti-infection treatment. İncluding antibiotics and continuors percutanouse drainage.
  15. 15. RESULT • When a nephrostomy catheter placement is planned in a patient who has hydronephrosis for any reason, advancing the guide wire into the renal pelvis as distally as possible instead of placing it in the ureter will likely reduce the risk of ureteral rupture that may be caused by nephrostomy.

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