Differential Diagnosis of Hematuria in the Emergency Department: Emphasizing Double J Stent-Inferior Vena Cava Fistula

Wenqi Qi ^1,2,3,4,5 Shou-Yin Jiang ^1,2,3,4,5* Shanxiang Xu ^1,2,3,4,5*

• ¹ Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Jiangsu Province, China
• ² Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine,, hangzhou, China
• ³ Zhejiang Key Laboratory of Trauma, Burn, and Medical Rescue, Hangzhou, China
• ⁴ Research Institute of Emergency Medicine, Zhejiang University, Hangzhou, China
• ⁵ National Emergency medical Rescue base, Hangzhou, China

Introduction: 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.Case Presentation: A Chinese male presented with acute left flank pain and gross hematuria persisting for four hours. 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.Conclusions: 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.