a 62 year old woman presented with intermittent gross haematuria of 3 days duration , 5 months ago . she was treated for carcinoma of the cervix 11 yrs previous with chemo  radiation , achieving complete resolution of the primary disease . at the time of presentation , in addition to mild radiation cystitis , there was suspicion of a stricture in the right ureter . after 3 months , a black silicone stent 6 fr , 26 cm ( cook medical ) was exchanged for the previously placed stent . this was treated each time with parenteral antibiotics . to evaluate the cause of fever the patient a ct scan was ordered , which revealed an extrusion of the upper end of the double j stent outside the renal parenchyma ( figure 1 ) . a review of prior x rays of the patient revealed the same finding , wherein the upper end of the stent was lying outside the renal outline ( figure 2 ) . ct scout image showing the proximal tip of the stent localized outsidethe outline of the right kidney . the patient 's symptoms were relieved , with no further episodes of uti in the 3 month follow up . ureteric stents are commonly used in urological practice for a variety of reasons including relief of obstruction , drainage of pyonephrosis , splinting of a ureteric repair or anastomosis . complications from insertion of ureteric stents are common  migration , encrustation and infections have been reported to occur . mehmet d. reported a case wherein a double j stent inserted after ureteroscopic removal of ureteric and renal calculi produced a perirenal haematoma from a parenchymal perforation . this was diagnosed on the first post operative day by ct scan following unexplained tachycardia and a drop in haematocrit . in an interesting study published in 1984 , salazar je pointed out that an x  ray done post insertion of a stent is an important confirmation of correct placement of the position of the stent . if the renal end of the stent is in a tight loop with the tip of the stent close to the long axis ( distance of tip of stent to the long axis of stent is less than the diameter of the stent ) , the stent has been correctly deployed . however , if the distance of the tip of the stent to the long axis is more than the external diameter of the stent , and the loop configuration is not tight , it is likely to be in a extra pelvic location . a review of the x rays of this patient showed that the loop was not in a tight loop and the tip of the stent was far away from the axis of the stent , pointing to extra pelvic location of the renal end of the stent . the urinary tract infections were possibly on account of transgression of parenchyma by the stent , since removal of the stent resulted in cure . we report a rare case of parenchymal perforation from insertion of double j stent presenting as recurrent urinary tract infection .
we present a rare case of renal perforation by a ureteric stent . a 62 yr old patient presented with repeated episodes of febrile urinary tract infections following double j stent placement . 
 a ct scan revealed the upper end of the stent lying outside the kidney , having pierced through the cortex . 
 removal of the stent cystoscopically resulted in cure of the symptoms . 
 post insertion of stents , it should be mandatory to confirm correct deployment of the stent via x  ray .