# Case Report: Differential diagnosis of hematuria in the emergency department: emphasizing double J stent-inferior vena cava fistula

## TL;DR

This case report describes a rare instance of iatrogenic hematuria caused by a double-J stent migrating into the inferior vena cava, highlighting the importance of imaging and clinical awareness.

## Contribution

The paper presents a rare clinical case of double-J stent migration into the inferior vena cava, emphasizing diagnostic and management considerations.

## Key findings

- Double-J stent migration into the inferior vena cava can cause persistent hematuria and requires imaging for detection.
- Conservative management and ureteroscopic removal resolved the condition effectively.
- Prior urologic interventions should be considered in the differential diagnosis of post-procedural hematuria.

## Abstract

Hematuria, a common clinical indicator of genitourinary tract pathology, arises from diverse etiologies including calculi, infections, malignancies, trauma, and iatrogenic causes. Initial evaluation requires hemodynamic assessment, identification of underlying causes, and urinary drainage optimization. This report highlights a rare case of iatrogenic hematuria secondary to double-J stent migration into the inferior vena cava.

A Chinese male presented with acute left flank pain and gross hematuria persisting for 4 h. Diagnostic imaging revealed a left ureteral stone, prompting double-J stent placement at a local hospital. Despite intervention, hematuria worsened, necessitating abdominal CT. Imaging identified proximal migration of the left double-J stent into the inferior vena cava, with no evidence of vascular injury. Due to concerns regarding inadequate drainage and infection risk, conservative management without catheter clamping was initiated prior to referral. Definitive treatment involved ureteroscopic stent removal under direct visualization at our institution, resulting in rapid symptom resolution.

This case emphasizes three critical clinical insights: (1) Persistent postoperative hematuria warrants consideration of iatrogenic causes, particularly following urologic device placement. (2) Imaging modalities, especially CT, are indispensable for detecting atypical stent migration. (3) Comprehensive history-taking must include prior urologic interventions to guide differential diagnosis. While double-J stent migration into major vessels remains exceptionally rare, its recognition prevents delayed management of potentially life-threatening complications. Clinicians should maintain heightened vigilance for device-related hematuria in patients with refractory symptoms post-procedurally, ensuring prompt imaging evaluation and multidisciplinary intervention when indicated.