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Colon perforation after percutaneous nephrolithotomy revisited.

Niels-Peter Noor Buchholz¹

¹United Lincolnshire Hospitals, Lincoln, UK.

Urologia Internationalis

|January 20, 2004

Summary

Percutaneous nephrolithotomy (PCNL) carries a rare risk of colon perforation, often without immediate signs. Awareness of aberrant retrorenal colon loops is crucial for urologists to prevent severe complications.

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Area of Science:

Urology
Surgical Complications
Gastrointestinal Surgery

Background:

Percutaneous nephrolithotomy (PCNL) is a common procedure for kidney stone removal.
A rare but serious complication involves injury to the colon, often undetected during the procedure.
Lack of pre-operative and intra-operative warning signs complicates early diagnosis.

Observation:

A patient developed signs of colonic perforation just before nephrostomy tube removal after an otherwise normal PCNL.
Despite no initial signs of sepsis or shock, severe complications arose during and after subsequent surgery.

Findings:

Aberrant retrorenal colon loops pose a risk during PCNL.
Perforation of such loops may go unnoticed during the procedure.
Post-operative abdominal symptoms warrant investigation for colonic injury.

Implications:

Urologists, surgeons, and radiologists must be aware of the risk of retrorenal colon perforation during PCNL.
Pre-operative CT scans should evaluate juxtarenal colon presence, though not routinely required for all PCNL evaluations.
Vigilance for abdominal symptoms is crucial for early detection and management of this rare complication.

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