A rare complication following ureteroscopic laser lithotripsy: a lethal case report of superior mesenteric artery thrombosis

Ureteroscopic laser lithotripsy (URSL) is widely regarded as a minimally invasive and safe procedure for ureteral stones, with thromboembolic complications being exceedingly rare. Superior mesenteric artery (SMA) thrombosis following URSL has not been previously reported in the literature. This case report presents the first documented fatal instance of SMA thrombosis after URSL, highlighting a critical postoperative hazard that necessitates heightened clinical awareness.

A 60-year-old female with significant vascular risk factors, including hypertension and prior stroke, was readmitted 10 days following an uncomplicated right URSL. She presented with rapidly progressive symptoms, evolving from right abdominal pain with nausea and vomiting to severe abdominal distension and hematochezia within days. Initial working diagnosis was urinary tract infection; however, contrast-enhanced computed tomographic angiography (CTA) revealed atherosclerotic plaque and an occlusive thrombus at the SMA origin, causing severe stenosis and extensive intestinal ischemia. Emergency exploratory laparotomy confirmed non-resectable necrosis of the entire small bowel. Given the irreversible intestinal damage and dire prognosis, no definitive resection was performed. The patient's condition deteriorated rapidly, leading to death approximately 11 hours postoperatively.

This fatal outcome underscores that even minimally invasive urological procedures like URSL may carry a potential risk for life-threatening thromboembolic complications, particularly in patients with pre-existing atherosclerotic disease. Unexplained or worsening abdominal pain in the postoperative period should promptly raise suspicion for mesenteric ischemia. We advocate for a low threshold for early investigation, including D-dimer screening and immediate contrast-enhanced abdominal CT, to facilitate urgent diagnosis and intervention, which are crucial for improving outcomes in this highly morbid condition.