[Bowel perforation after extracorporeal shock wave lithotripsy: a case report]

A case of intestinal perforation caused by ESWL for left ureteral calculus is reported. A 69-year-old male underwent the graft replacement for bilateral iliac aneurysm in March, 1996. In February, 1999, there appeared left flank pain, and a diagnosis of left ureterolithiasis was made by radiological examination. On March 29 he was admitted to our department for ESWL. On March 30, ESWL for calculus in the pelvic region was performed with the patient in the prone position. The patient complained of the left lower abdominal pain immediately after ESWL, but no muscular defense was observed. Since the pain was not relieved, CT was performed on March 31, but no evident abnormal finding was found. Thereafter the pain continued and on April 2 muscular defense was also noted. On CT performed a second time, free air and evidence of ileus were found, so emergency operation was performed. Two perforations about 2 mm in size were found in the jejunum 130 cm from the Treitz' ligament, which led to diagnosis of intestinal perforation due to ESWL. The patient followed a satisfactory postoperative course and was discharged on April 23. There has been only one reported case of intestinal perforation due to ESWL. It is a very rare complication. However, this complication should be taken into consideration where the patient has the history of abdominal surgery and where ESWL was performed with the patient in the prone position.