Ureteral and renal vein perforation with placement into the renal vein as a complication of the pigtail ureteral stent.

A 43-year-old woman with recurrent colon carcinoma presented with bilateral pelvioureteral obstruction. After a 6F ureteral catheter had been in place for 4 days the left ureter was perforated near the ureteropelvic junction, while an attempt was made to insert a 7F Cook indwelling pigtail ureteral stent. The errant stent was allowed to remain in its extraureteral locale until urinary drainage was established. To our surprise the stent had been placed into the renal vein, after exiting the ureter 2 cm. inferiorly. There was excellent tamponade. When the large stent was removed severe bleeding ensued that was controlled by ligatures. Methods to prevent perforation are discussed. Should perforation of these stents occur in the proximal ureter or renal pelvis it would seem judicious to leave these in place rather than perform any further endoscopic manipulation before surgical inspection.