Forgotten Perinephric Drain Anchored in the Tissues: Lessons to Be Learned.

Background: Drainage of any deep seated abscess often requires placement of catheters along with other conservative measures. These catheters are removed when the drainage volume reduces to clinically insignificant levels. However, if left in situ , there are potential complications. One such complication necessitating additional surgical procedure is highlighted in this case report. Malecot's catheter and children may be more at risk for such a complication. Case Presentation: A 7-year-old girl presented with recurrent episodes of right flank pain associated with high-grade fever with chills for the last 5 months and right perinephric drain in situ . She had earlier presented at an outside center and was found to have bilateral renal calculi and left lower ureteral calculi along with right perinephric abscess and pyonephrosis. She underwent right perinephric drain and bilateral Double J (DJ) placement 4 months ago. The perinephric drain initially drained around 250 mL pus each day and progressively ceased to drain by 15-20 days. However, the drain was left in situ and the girl was referred for management of bilateral renal and left ureteral calculi. Pending her consultation, the drain and stents remained forgotten. At presentation, blood urea and serum creatinine were 20 and 0.2 mg%, respectively. Urine culture was sterile. Non-contrast computerized tomography kidney, ureter, and bladder radiograph showed right perinephric drain, bilateral DJ stents with bilateral renal (lower and middle caliceal) calculi, and a chain of left upper ureteral calculi. A small loculated subcapsular collection was also noted at the lower pole of right kidney. All efforts made to pull out the drain under local anesthesia were in vain. The drain was found to be impacted and could not be taken out. Decision was taken to remove the drain laparoscopically. Drain was removed effectively and B/l DJ stents were changed followed by staged procedure for calculi. Conclusion: Malecot catheters may be more prone to ingrowth of tissue because of their inherent design of wider holes, all located at the tip of the catheter. This unique case emphasizes the need for careful follow-up of a patient with perinephric drain and difficulties with the removal of a Malecot catheter compared with a pigtail catheter, particularly in children. Laparoscopic removal of retained Malecot catheter as perinephric drain is a safe option of treatment in such a case.