Bowel perforation during percutaneous renal surgery

We report the case of a 74 years old patient presenting bowel lesion in a percutaneous renal surgery to extract a 2.5cm diameter stone.

The access to percutaneous nephrostolithotomy was performed between the 11th and 12th left ribs at the posterior axillary line. An abdominal transversal pad was placed and a guide was passed down the ureter with no difficulty. Surgical time was of approximately 40 minutes. Antegrade pielography performed at the end of the procedure was normal. In the first post-operative day, the patient presented severe pain and abdominal defense. An additional descendent pielography was performed gently pulling the nephrostomy catheter, thus contrasting the bowel. The patient underwent an exploratory laparotomy where lacerations in left colon external wall and a bowel transfixing lesion were found. Non-absorbable sutures in two layers were performed. The patient presented a good progress with no occurrences during post-operative period, and was discharged in one week.