Biliary peritonitis due to gall bladder perforation after percutaneous nephrolithotomy

Area of Science:

• Urology
• Gastroenterology
• Surgical Complications

Background:

• Percutaneous nephrolithotomy (PNL) is a common procedure for kidney stone removal.
• Gallbladder (GB) injury is an exceptionally rare complication associated with PNL.
• This report details a case of fatal GB perforation following PNL.

Observation:

• A 19-year-old male underwent PNL for a 1.5 cm lower pole renal calculus.
• The procedure was technically successful with complete stone removal.
• Forty-eight hours post-PNL, the patient presented with peritonitis and shock.

Findings:

• Exploratory laparotomy revealed hemoperitoneum with multiple GB perforations and a liver injury.
• The patient underwent retrograde cholecystectomy but did not survive.
• This case demonstrates a high mortality rate associated with GB perforation post-PNL.

Implications:

• This case underscores the potential for severe, life-threatening complications from PNL.
• The lack of early clinical signs for GB perforation poses a diagnostic challenge.
• Increased awareness and vigilance are crucial for managing suspected GB injury after PNL.