Case report: minimally invasive management of two major complications of colonic perforation and pseudoaneurysm formation following nephrostomy tube placement

Marie-Lou Letouche^1,2,*, Aideen Madden^2,3, Mariela Corralles^2,3, Steeve Doizi^2,3, Olivier Traxer^2,3
1 Urology Service, CHU Tours, 2 boulevard Tonnellé, Tours, 37000, France
2 GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, 75020, France
3 Urology Service, AP-HP, Hopital Tenon, Assistance-Publique Hopitaux de Paris, Sorbonne Universite, 4 Rue de la Chine, Paris, 75020, France
* Corresponding Author: Marie-Lou Letouche. Email: email

Canadian Journal of Urology https://doi.org/10.32604/cju.2025.067253

Received 28 April 2025; Accepted 01 September 2025; Published online 09 October 2025

Abstract

Background: We present a case of two major complications following insertion of a nephrostomy managed in a minimally invasive way. Our case is the first in the literature to describe this minimally invasive treatment technique for colon perforation in a completely asymptomatic patient. Case Description: A 75-year-old female patient with a history of bilateral obstructive uropathy secondary to bilateral radiation-induced ureteric strictures attended for bilateral nephrostomy placement. The patient had a history of endometrial cancer, treated previously by total hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemo-radiotherapy and brachytherapy. Her recovery had been further complicated by the development of radiation cystitis, small bowel resection, and short gut syndrome. The strictures had previously been managed with bilateral double J stents, which have now failed. A left-sided nephrostomy insertion was performed. A CT-scan prompted by a repeat deterioration in renal function revealed a right-sided hydronephrosis and suggested transcolic passage of the previously placed left-sided nephrostomy. She had remained clinically well and apyretic. A right-sided nephrostomy was inserted, and the left re-sited following a colonoscopy-guided nephrostomy removal and clip occlusion of the nephrostomy tract. The patient then developed a pseudoaneurysm, which was managed with embolization. The patient was able to return home with corrected kidney function. The three-monthly checks for changes in nephrostomy catheters did not reveal any complications. Conclusions: The patient therefore presented with two major complications of nephrostomy placement: colonic perforation and pseudoaneurysm, classified as Clavien IIIb and IIIa, respectively. Multidisciplinary management, including urologists, gastroenterologists, general surgeons, and radiologists, enabled a minimally invasive management. Minimally invasive management with endoscopic clip placement appears to be a safe alternative to directed fistula of colonic perforation.