Biliary peritonitis following percutaneous nephrolithotomy: Minimally invasive management

Area of Science:

• Urology
• Gastroenterology
• Surgical Complications

Background:

• Percutaneous nephrolithotomy (PCNL) is a primary treatment for large kidney stones.
• Biliary tract injury is a rare but serious complication of PCNL.
• Traditional management for PCNL-induced biliary injury involves emergent surgery.

Observation:

• A patient developed biliary peritonitis following PCNL due to gallbladder injury.
• The condition presented with sepsis, a severe outcome of biliary leakage.
• Standard treatment would typically necessitate gallbladder removal (cholecystectomy).

Findings:

• This case was successfully managed with a less invasive strategy.
• An abdominal drain was placed to manage the bile collection.
• Endoscopic retrograde cholangiography (ERC) with common bile duct stenting was performed to divert bile flow.

Implications:

• Minimally invasive techniques can be effective for managing rare PCNL complications like biliary injury.
• Endoscopic stenting offers an alternative to surgery in select cases.
• This approach may reduce patient morbidity associated with open or laparoscopic surgery.