title: Complete intraperitoneal displacement of a double J stent: a first case.
abstract: OBJECTIVE
  Ureteral double-J stents are known to migrate proximally and distally within the urinary tract, while perforation and stent displacement are uncommon. Possible mechanisms of displacement are either original malpositioning with ureteral perforation or subsequent fistula and erosion of the excretory system, due to infection or long permanence of the device. We present the unique case of complete intraperitoneal stent migration in a 59-year-old caucasian male without evidence of urinary fistula at the moment of diagnosis, so far an unreported complication.
  
  
  METHODS
  Eight months after the placement of a double-J stent for lower right ureteral stricture at a district hospital, the patient came at our observation for urosepsis and hydro-uretero-nephrosis. A CT scan demonstrated intraperitoneal migration of the stent outside the urinary tract. Cystoscopy failed to visualize the lower extremity of the stent, a percutaneous nephrostomy was placed to drain the urinary system and the stent was removed through a small abdominal incision on the right lower quadrant.
  
  
  RESULTS
  In our case we presume that during the positioning manoeuvre the guide wire perforated simultaneously the lower ureteral wall and the pelvic peritoneum, and that once the upper end of the stent was coiled, the lower extremity was also attracted intraperitoneally. The lack of pain due to the spinal lesion concurred to this unusual complication.
  
  
  CONCLUSIONS
  We must be aware that ureteral double J stents may be found displaced even inside the peritoneal cavity, and that the use of retrograde pyelography during placement is of paramount importance to exclude misplacement of an apparently normally coiled upper extremity of the stent.
authors.affiliation: Department of Translational Research, Section of Urology, University of Pisa. fm.turri@gmail.com.
authors.forename: Filippo Maria
authors.initials: FM
authors.lastname: Turri
authors.forename: Francesca
authors.initials: F
authors.lastname: Manassero
authors.forename: Andrea
authors.initials: A
authors.lastname: Mogorovich
authors.forename: Maurizio
authors.initials: M
authors.lastname: De Maria
authors.forename: Andrea
authors.initials: A
authors.lastname: Falleni
authors.forename: Cesare
authors.initials: C
authors.lastname: Selli
mesh_terms: D020878:Device Removal; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D010532:Peritoneal Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D015607:Stents / Q000009:adverse effects*; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery; D014552:Urinary Tract Infections / Q000209:etiology; D014567:Urography / Q000379:methods