Accidental pigtail in the inferior vena cava, a danger averted: A case report and review of literature

Percutaneous nephrostomy (PCN) is a common procedure performed in emergencies for obstructed and infected kidneys. While complications like sepsis, bleeding, pain, dislodgement, and accidental injuries to the colon, small intestine, and other visceral organs have been reported, cases of nephrostomy tube placement in the inferior vena cava (IVC) remains anecdotal. We present a rare case of accidental PCN placement in the IVC of a patient with prostate carcinoma and bilateral hydronephrosis. The patient underwent exploration, safe removal of the misplaced PCN, and correct placement into the renal pelvis. Although PCN insertion is generally a simple procedure, catastrophic complications like hemorrhage, and intestinal and other visceral injuries have been documented. This procedure requires precise puncture through the papilla and careful monitoring of the dilatation with ultrasound and fluoroscopy. We describe this case along with a review of the literature on managing accidental PCN placement in the IVC.