a double j stent ( djs ) also known as  jj stent  forms an integral part of the armamentarium in an endourology set up . the relative indications of djs after an ureteroscopy include ureteroscopy for an impacted ureteric stone , solitary kidney or any endourologic procedure performed bilaterally . the well - known complications of djs include encrustation , fragmentation , distal , and proximal migration , stenturia , and severe lower urinary tract symptoms which include dysuria . most of these complications are self limiting and can be managed with suitable conservative and endourologic interventions . a 43-year - old female patient presented to our out - patient department with history of attempted ureteroscopy for a lower ureteric calculus elsewhere . the operating surgeon had difficulty in negotiating the ureter and could not reach the stone . the procedure was performed without fluoroscopy control , a 0.038 inch guidewire and 8fr semi - rigid ureteroscope were used . the surgeon could not reach the stone because of poor vision and hence placed a djs with difficulty . the cect showed a migrated djs into the external iliac vein with the upper end seen in the inferior vena cava and the atrium . the cect did not show the lower end of the stent in the bladder [ figure 1 ] . cect shows a ) stent in the inferior vena cava ( ivc ) ; b ) stent seen in the right atrium ; c ) the stent is seen in the ivc adjacent to the contrast filled lumen of the ureter we planned a ureteroscopy and removal of the migrated stent . a semi - rigid ureteroscopy was performed ; the lower ureteric calculus was visualized , fragmented , and removed . the ureteroscope was negotiated into the upper ureter but the stent could not be visualized , confirming complete extrusion of the stent and its subsequent extra anatomic migration in the external iliac vein as suggested on cect [ figure 2 ] . the patient was explored through a gibson 's incision , vascular control was gained proximally and distally on the external iliac vein with a satisnsky clamp and the stent was removed [ figure 2 ] . note that the lower end is not coiled and the upper end extends beyond the thoracic cage . open exploration was done , proximal and distal control of external iliac vein ( eiv ) was obtained and stent was removed under vision the common complications of djs include encrustation , fracture , and migration proximally and distally . there are situations where the stent has to be placed in an antegrade manner , these instances include those with obstructive uropathy due to pelvic malignancy . rao et al . , described their experience with extra anatomic complications with antegrade double j stenting . the authors postulated that the risk factors for occurrence of such complications include pelvic malignancy , surgery and prior history of ureteric reimplantation . in addition , they noted that a stent adjacent to any vascular structure is prone to vascular erosion . in our patient , due to the impacted stone , the surgeon probably had difficulty in placing the 0.038 inch guidewire which may have gone submucosally into the vessels . later , the stone could not be approached because of poor vision and the surgeon decided to defer the procedure and place a stent . the stent was inserted under cystoscopy monitoring and probably did not coil in the bladder , leading to migration into the lower ureter and the iliac vessel . although rare , intravascular migration of djs has been reported following pyelolithotomy . michalopoulos et al . , reported pulmonary thromboembolism because of migration of stent into the heart and left pulmonary arterial system after a pyelolthotomy . another recent report describes migration of a ureteric stent into the vascular system with endovascular removal . it is imperative that the surgeon not force the guidewire while negotiating a tight narrowing / stricture or an impacted stone . if there is a doubt regarding the proper position of the wire , a contrast study done with a double lumen catheter will help . third , the surgeon should have a high degree of suspicion if the patient has unusual symptoms such a severe pain , severe hematuria after djs insertion . finally , a postoperative x - ray would show an abnormal lie of the stent and raise doubts . the upper end of the stent is appeared to be in the thorax [ figure 1 ] while the lower end was not coiled in the bladder . the treatment options in such a case include endovascular intervention , endourologic removal , and open surgical removal . the treatment is dictated by position of the distal coil of the djs , the general condition of the patient , available expertise , and infrastructure . an access sheath inserted through the femoral vessel acts as a conduit for removal of the foreign body . open surgical removal is a safe and efficacious option if expertise for endovascular intervention is not available .
migration of a ureteric double j stent down into the bladder or up into the kidney is a well known complication . 
 we recently encountered a case where the stent migrated into the vascular system following attempted ureteroscopy for a lower ureteric calculus . 
 the patient required open surgical exploration for stent retrieval .