Conservative management of colonic injury during percutaneous nephrolithotomy

Abstract

Objectives: Colonic injury is a rare but serious complication of percutaneous renal surgery. Its clinical course may be elusive and an awareness of the various presentations is of great importance. We describe how early diagnosis and a diligent conservative approach have resulted in a favorable outcome in our series.

Patients and methods: From 2005 to 2015, 2150 percutaneous nephrolithotomy (PNL) procedures were performed in our center. Patients’ records were searched for the occurrence of colonic injury. Records were reviewed and we report on the preoperative data, the clinical presentation and the management approach in these cases.

Results: Three patients (0.14%) were identified with colonic injury following PNL, the three injuries were in male patients with a median age of 36.6 (range 28–45 years). Two injuries were on the left side and one on the right. Two of our patients had a low BMI. The renal puncture was in the lower posterior calyx in two and in the middle calyx in one. The diagnosis was established postoperatively in all and confirmed using antegrade or retrograde pyelography. All patients were managed conservatively with a favorable outcome.

Conclusion: An approach combining a high degree of suspicion for early diagnosis and a diligent conservative management results in a favorable outcome in patients with colonic injury during PNL.

Keywords: Percutaneous nephrolithotomy; Complication; Colonic injury; Urolithiasis; Kidney calculi