Abstract
A 50-year-old female with left flank pain and 3.1 cm renal calculi underwent PCNL. Intraoperatively, an anatomical variant led to accidental insertion of a nephrostomy tube into the inferior vena cava (IVC), while a second tube was correctly placed. Postoperative edema prompted CT imaging revealing the malposition. The misplaced tube was incrementally withdrawn under CT guidance over days to prevent bleeding complications, then repositioned successfully. Three-month follow-up confirmed resolution of hydronephrosis, absence of strictures or bleeding, and complete wound healing. This case underscores the necessity of intraoperative anatomical vigilance and staged management of iatrogenic vascular injuries during PCNL.