Percutaneous nephrostomy (PCN) defined as Image-guided placement of a catheter through a calyx into the renal collecting system which can be localized by one or more cross-sectional techniques, such as ultrasonography, computed tomography (CT), or rotational fluoroscopic acquisition (cone-beam CT). It has been widely used to treat intrinsic or extrinsic urinary tract obstruction. Etiologies include, but are not limited to, stones, malignancy, and iatrogenic conditions. Urinary tract obstruction may be present without or with infection. Few major complications have been associated with percutaneous nephrostomy. Few publications have reported the misplacement of nephrostomy tube into the inferior vena cava (IVC), usually following percutaneous nephrolithotomy.

We report the case of a patient with persistent bloody output at inserted nephrostomy tube after clamped for 24 hours. In this procedure, the nephrostomy tube passed through the renal parenchyma and renal vein and into contralateral renal vein traversing the inferior vena cava.

The patient underwent exploratory laparotomy, removal of the nephrostomy tube with no untoward complications.

We concluded that although PCN is relatively simple procedures, they should be done cautiously preferably under ultrasound or fluoroscopic guidance.