Case Report: Ureteral double-J stent placement: a rare case of ureteral perforation complicated by periureteral abscess.
Zhou Tao T, Yao Lei L
This case report presents the first documented instance of ureteral perforation complicated by a periureteral abscess following double-J stent placement. The diagnostic and therapeutic experience is summarized herein. An 83-year-old female with type 2 diabetes mellitus and ureteral calculi underwent ureteral stent insertion for stone-induced obstruction. Subsequently, she developed ureteral perforation accompanied by a periureteral abscess. Management involved stent removal, left percutaneous nephrostomy, ultrasound-guided abscess drainage, and targeted antibiotic therapy. Eventually, the patient's symptoms resolved, the abscess was completely absorbed, and no recurrence was observed during follow-up. Double-J ureteral stent insertion can lead to numerous life-threatening complications. Improper stent placement may result in ureteral perforation and subsequent periureteral abscess formation. This risk is particularly elevated in elderly diabetic patients with chronic infection due to ureteral calculi, as the ureteral wall is fragile and prone to perforation during retrograde catheterization. Percutaneous nephrostomy may represent a more appropriate strategy for relieving obstruction in such cases. If stent insertion is performed, forceful maneuvers must be avoided during the procedure, the procedure should be performed under fluoroscopic guidance and early postoperative CT imaging is recommended to confirm proper stent positioning. Ureteral perforation typically heals spontaneously without surgical repair. Once a periureteral abscess develops, prompt percutaneous drainage is essential, as antibiotic therapy alone has limited efficacy.