Perforation of the bowel during SWL in prone position

Area of Science:

• Urology
• Gastroenterology
• Medical Devices

Background:

• Extracorporeal shock wave lithotripsy (SWL) is a common treatment for kidney and ureteral stones.
• The prone position is sometimes used for SWL, particularly for ureteral stones.
• Potential complications of SWL, while rare, are an ongoing area of investigation.

Observation:

• A patient undergoing SWL for a ureteral stone in the prone position experienced a small bowel perforation.
• The treatment involved 4500 shockwaves delivered at a high energy setting.
• No predisposing factors for gastrointestinal injury were identified besides the high number and energy of shockwaves.

Findings:

• This case represents the first reported instance of small bowel perforation directly linked to SWL.
• The trajectory of shockwaves through the peritoneal cavity in the prone position appears to be a significant risk factor.
• The high number of shockwaves and high energy levels were implicated in the bowel injury.

Implications:

• SWL in the prone position necessitates careful consideration of potential risks to abdominal organs.
• Modifying SWL parameters, specifically reducing the number and energy of shockwaves, may be crucial for patient safety in this position.
• Further research into the safety profile of SWL in the prone position is warranted to refine treatment protocols.