Puncture of the iliac artery during endoscopy is a rare complication rarely described in the literature but potentially serious1.
Endoscopy2 is a safe procedure for diagnosis and treatment of upper urinary tract pathology.
We report the case of a 35-year-old woman scheduled for removal of a Double J Catheter (DJC) migrated to the left renal pelvis by endoscopy.
Personal history: Characterize of Cervix 6 years ago treated with Hysterectomy and Double adnexectomy.
QT and subsequent RT, currently in remission.
He had developed complications such as right intestinal fistula requiring surgical closure, bilateral ureteral stenosis secondary to retroperitoneal fibrosis treated with bilateral double J catheter, making periodic changes thereof.
The patient was referred from another center for removal of CDJ lodged in the renal pelvis.
The procedure is performed under general anesthesia.
After monitoring heart rate (HR), non-invasive blood pressure (NIBP) and SatO2, a large caliber peripheral catheter is channeled and induction is performed with fentanyl 1 μg/kg and a nasogastric tube with propofol 2 mg/kg.
Maintenance with remifentanil 0.1 μg/kg/min according to HR and NIBP, propofol 10 mg/ml for a bispectral index (BIS) 40-60.
During dilatation, a stenotic zone was observed at the level of the pelvic ureter, which did not allow the placement of a volvulus balloon, which was performed in order to find great difficulty.
Although the lack of progression was attempted on the guide, a control pyelogram was performed using a window where a contrast passage to the common iliac artery was observed.
The surgeon advised to perform a right radial artery cannulation with Allen's prior test and right internal jugular central vein, both without incidents; invasive blood pressure (IBP) and central venous pressure were monitored.
Blood count was requested at baseline (Hemoglobin 13.9 mg/dL), crossed urgent tests and Fresenius Hemocare® was prepared.
The patient remains hemodynamically stable without the need for vasoactive drugs with a heart rate of around 55 beats per minute and mean BP of approximately 80 mm Hg, so an expectant anesthetic attitude was decided.
The interventional vascular radiology service proceeded to endovascular stent grafting covered by percutaneous femoral approach without removal.
Later, left Nephroscopy was performed extracting the migrated CDJ, leaving a percutaneous nephrostomy and placing a new CDJ, uneventfully passing the two procedures.
There is evidence of significant bleeding, in analytical control reflects Hb 10.8 mg/dL and it was decided to start transfusion of two concentrates of anemia (CH), with intent to treat bleeding.
Reactive image was removed from the patient due to bleeding, recovering consciously and using the supraglottic device without any novelty. The patient required a transfusion in the hospital ward, with the objective of monitoring the patient in the immediate postoperative period.
1.
Finally, we can conclude in the first place that we must always wait for the unexpected, although in this case all the surgical antecedents, radiotherapy, fibrosis in the wrong zone made much more likely the appearance of complications; in the second place we realize that the communication anticipates, we do not see that the defective
Finally we want to draw attention to the laryngeal mask that allowed effective ventilation of the patient throughout the procedure.
