A Case of Renal Pelvi-venous Fistula Diagnosed by Nephrostogram: A Rare Complication of Percutaneous Nephrostomy

Abstract

Percutaneous Nephrostomy (PCN) is a minimally invasive procedure used in patients with hydronephrosis. Major haemorrhagic complications requiring transfusions occur in 1-4% of PCNs, while major vascular injuries (requiring embolisation or nephrectomy) occur in 0.1-1% of cases. The sources of bleeding are usually from pseudoaneurysms or Arteriovenous (AV) fistulas when the nephrostomy tract passes near the renal hilum. A calyceal-venous or renal pelvi-venous fistula is a rare but significant complication that can arise following PCN, ureteric obstruction, and renal transplantation. Invasive treatment options for managing these fistulae include transvenous embolisation, external drainage to relieve outflow obstruction, and open surgical management, which may involve closure of the fistula, partial nephrectomy, or complete nephrectomy. Hereby, the authors present a case of 74-year-old male patient with carcinoma of the urinary bladder, who had a history of bilateral PCN due to vesico-ureteric junction involvement. He presented post-procedure with continuous haematuria from the left PCN catheter. There was a significant drop in haemoglobin; however, the patient remained vitally stable. A nephrostogram performed by injecting contrast via the PCN catheter revealed a renal pelvis-renal vein (pelvi-venous) fistula. He was managed by placing a pigtail catheter with its tip in the mid-ureter to provide external drainage and a tamponade effect at the fistula site. The haematuria gradually resolved within two days, with clear urine output. Therefore, the authors aimed to draw attention to the rare finding of a renal pelvi-venous fistula on nephrostogram following PCN and its management through the repositioning of the nephrostomy tube.

Keywords

• carcinoma
• embolisation
• haematuria
• nephrectomy
• pigtail catheter
• postoperative complication