Conservative management of colon injury following percutaneous renal surgery

Colon injury during percutaneous renal surgery is rare and can result in significant morbidity. Our objective was threefold: (1) to identify risk factors for colon injuries; (2) to optimize prevention of such injuries; and (3) to devise a treatment strategy for optimal management of such colon injuries.

Between July 1990 and July 1995, all percutaneous renal procedures performed at three kidney stone centers were reviewed (Kaiser Permanente Medical Center, Los Angeles; Hospital of the Good Samaritan, Los Angeles; and University of California at San Francisco). In addition, a review of the pertinent literature was performed.

Five patients who suffered colon injuries during percutaneous renal surgery were identified. All had undergone percutaneous nephrolithotomy, and all injuries were extraperitoneal. Mean age was 31 years (range 17 to 52). Three patients were considered lean, and the other two were of average body habitus. Four of 5 patients were male. Three injuries occurred on the left side and two on the right. Recognition of colon injury occurred postoperatively in 4 patients and intraoperatively in 1 patient. Presenting signs and symptoms included fever, fecaluria, abdominal pain, and leukocytosis.

High risk patients for colon injuries are young, lean males with minimal retroperitoneal fat, in whom a retrorenal colon is more likely. High risk patients should be accessed with a more superior and medial puncture. Retroperitoneal colon injuries can be successfully managed conservatively with early recognition and appropriate drainage of the urinary and intestinal tracts. A treatment algorithm is presented.