The Management And Discussion Of Perforation In Renal Vein And Inferior Vena Cava During Percutaneous Nephrostolithotomy (2 Cases Report)

Objective To summarize the causes and management of perforation in renal vein and inferior vena cava during percutaneous nephrolithotomy.Methods Between 2013 and 2015, injury and intravenous misplacement of a nephrostomy tube occurred in 2 cases during PCNL were retrospectively analyzed.2 cases were male, age 72 years old and 26 years old, suffering massive haemorrhage by puncturing and establishing channels during PCNL respectively in our hospital and another, a percutaneous nephrostomy(PCN) catheter was inserted promptly through the sheath and closed,then PCNL was terminated.THE PCN catheters were malpositioned into renal vein and inferior vena cava, which was confirmed by spiral CT scan after surgery.The 72 years old patient underwent laparotomy in the operating room 7 days postoperatively to pull out the PCN catheter,repair the fistula and tissue surrounding and remove stones by slicing renal pelvis.The 26 year old patient was transferred to our hospital and underwent laparotomy 14 days postoperatively to remove the stone by slicing ureter, pull out the PCN catheter,repair the fistula and tissue surrounding.Results After operation performed successfully of both two cases, the hemorrhage were controlled, without bleeding happened again via fistula or further renal function damage.Conclusion Injury and intravenous misplacement of a nephrostomy tube in renal vein and inferior vena cava during PCNL can be confirmed by CT.It can be managed by Pulling out the PCN catheter,repairing fistula and removing calculus concurrently via laparotomy reliably and efficiently.