Delayed Bleeding After Retrograde Intrarenal Surgery: A Rare Complication in Ectopic Pelvic Kidney

Anatomical variations in the pelvic ectopic kidney (PEK) present many challenges to stone treatment. Retrograde intrarenal surgery (RIRS) has emerged as the treatment of choice for small to medium stones. We present a case of delayed hemorrhage due to an arteriocaliceal fistula. A 57-year-old man with a 12 mm middle calyx stone was subjected to uneventful RIRS, despite a high grade of scope deflection. Recovery was unremarkable until 37 days after surgery when the patient started recurrent hematuria and clot retention. Renal angiography revealed a bleeding vessel from an arteriocaliceal fistula. Superselective arterial embolization was successfully performed. Anomalous collecting system and vasculature can increase the risk of complications in PEKs. Massive bleeding from unusual arterial blood supply was effectively treated by angioembolization.