Management of intraoperatively diagnosed colonic injury during percutaneous nephrostolithotomy

Colonic injury associated with percutaneous nephrostolithotomy is an unusual event. Significant and morbid sequelae can be avoided through careful evaluation and management, which is facilitated by intraoperative diagnosis. Factors predisposing to colonic injury during percutaneous nephrostolithotomy include a lower caliceal access site, lateral origin of the percutaneous puncture, left-sided kidney, female patient, advancing patient age, and thin body habitus of the patient. Principles of management include inspection of the percutaneous nephrostolithotomy tract for colonic injury whenever the tract is inspected for bleeding, high index of suspicion for colonic injury when a patient develops unexplained signs or symptoms of inflammation or infection postoperatively, and prompt, assured drainage of both the colon and urinary collecting system.