Colonic perforation during percutaneous nephrolithotomy: An 18-year experience

Aslzare, Mohammad; Darabi, Mohammad Reza; Shakiba, Behnam; Gholami-Mahtaj, Leila

doi:10.5489/cuaj.1646

Cited by 21 publications

(20 citation statements)

References 16 publications

(19 reference statements)

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“…CP is a very rare complication of PNL that was seen in at a rate of 0.3 % in 15 cases in the largest study to date [4]. In the other case series study CP was observed in 11 (0.2 %) out of 5260 PNL cases [9]. To the best of our knowledge, our study is the largest one to date, which includes 22 patients.…”

Section: Discussionmentioning

confidence: 71%

“…There are some case reports and a limited number of patient series in the literature that evaluate the risk factors and present diagnosis and treatment modalities of CP related to PNL [4,[7][8][9]. Herein, to the best of our knowledge, we present our experience with the largest series of CPs as complication of PNL and discuss the diagnosis and management of this complication in light of the current literature.…”

Section: Introductionmentioning

confidence: 96%

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Colon perforation related to percutaneous nephrolithotomy: from diagnosis to treatment

et al. 2015

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We present our experience with the largest series of colon perforation (CP) as complication of percutaneous nephrolithotomy (PNL). From January 1998 to August 2014, 22 cases that presented with PNL-related CP from seven referral centers were retrospectively reviewed. The patients with CP were evaluated in terms of probable risk factors. Peri-operative and postoperative findings, timing of diagnosis, and treatment modalities of the CP were reviewed. Of the 22 patients, previous ipsilateral renal surgery (n:2) and retrorenal colon (n:5) were the risk factors for CP. The CP was directly visualized via nephroscopy during the surgery in 3 (13.6%) and with nephrostography at the end of the procedure in 4 patients (18.2%). In two patients, perforation was realized via the passage of contrast into the colon with nephrostography on the postoperative second day. Postoperative passage of feces through the nephrostomy tube was seen in six patients. The clinical signs in 13 cases directed CP diagnosis. The confirmation of the CP was achieved with a CT scan in all the patients. The patients with extraperitoneal perforation were primarily managed conservatively. Open surgical treatment was performed in cases with intraperitoneal perforation (n:5) and those with extraperitoneal perforation resistant to conservative treatment (n:5). Meticulous evaluation of the risk factors preoperatively is the initial step in the prevention of CP. Timely diagnosis plays essential role in the management of this PNL complication. Although extraperitoneal CP may be managed conservatively, surgery is required for intraperitoneal CPs.

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Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 96%

Colon perforation related to percutaneous nephrolithotomy: from diagnosis to treatment

et al. 2015

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“…The frequency is reported as 0.2% to 0.3%. [3][4][5] Risk factors were age, dilated collecting tubules, horseshoe kidney, and retrorenal colon. [6][7][8][9] In colon perforation cases, conservative management should be the first line of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Colon perforation is a rare, but dangerous, complication; its frequency occurs between 0.2% and 0.3% of the time. 2,3 Colonic perforation might have serious consequences if it is not diagnosed early. 4 …”

Section: Introductionmentioning

confidence: 99%

Colon perforation during percutaneous nephrolithotomy and fistula closure with Spongostan following conservative therapy

Ün

Çakır²,

Köse³

et al. 2015

CUAJ

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Percutaneous nephrolithotomy (PCNL) is the first-line treatment for kidney stones. Colon perforation is a rare, but dangerous, complication. Colonic perforation might be very serious if it is not found early. After an unsuccessful extracorporeal shockwave lithotripsy, a 45-year-old female underwent a left-sided PCNL for two 1-cm kidney stones in the left kidney upper pole calyx. During dilatation, a colon perforation was suspected. The procedure was finished by inserting a 14Fr re-entry catheter into the colon. On postoperative day 5, a fluoroscopy was performed by injecting contrast dye through the re-entry catheter, which showed a fistula formation between skin and colon. The catheter was removed completely. A 16Fr external drainage catheter was inserted over the guidewire through the fistula tract. The fistula was closed by introducing prepared absorbable hemostatic gelatin powder (Spongostan) particles into the fistula tract through the catheter. Fistula tracks can be closed early by injecting absorbable Spongostan particles into the colonic fistula tract, thereby reducing inpatient time and increasing patient comfort.

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“…According to the Clavien-Dindo classiication of surgical complications, colonic injury is regarded as a stage IVa complication. The incidence of colon injury is reported to be 0.3-0.5%, however in a large recently reported series, AslZare et al [36] noted 11 cases in 5260 cases of PCNL. Colonic injuries are seen in patients with retro-renal colon, the prevalence of retro-renal colon in males to be 13.6% on the right and 11.9% on the left, whilst in females it was 13.4% on the right and 26.2% on the left [37].…”

Section: Ct Beyond the Diagnosis Of Stonementioning

confidence: 99%

Non-contrast CT in the Evaluation of Urinary Tract Stone Obstruction and Haematuria

Ather¹,

Memon²,

Aziz³

et al. 2017

Computed Tomography - Advanced Applications

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Non-contrast computed tomography (CT) abdomen has emerged as a irst line investigation in suspected upper urinary tract obstruction. Underlying causes can usually be ascertained on computed tomography of kidneys, ureters and bladder (CT KUB). However, further investigations may be required to delineate/conirm underlying pathology like ureteropelvic junction obstruction (UPJ), diferentiation between obstruction and residual dilatation. Actual protocol of CT KUB for evaluation of stone disease and haematuria vary on institutional guidelines. CT KUB is not only extremely sensitive and speciic in the diagnosis of stone; it is now used in the pre-operative nomograms in predicting success of various endourological interventions like percutaneous nephrolithotomy (PCNL) and shock wave lithotripsy (SWL). Determination of stone density, stone volume, stone composition, skin to stone distance, presence of ureteral wall oedema, perinephric oedema are highly predictive of stone free rate. CT recognition of various anomalies, presence of retro-renal colon, horse-shoe kidney, malrotation, etc. can help in beter planning to avoid complications. One of the major limitations of CT is the radiation dose, besides cost and availability. Modiication in technique and technological innovation has resulted in signiicant dose reduction from 4.5 to about 1 mSv.

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Colonic perforation during percutaneous nephrolithotomy: An 18-year experience

Abstract: Early diagnosis and conservative management of colonic perforation can minimize patient morbidity and mortality and result in excellent healing of the fistulous tract without any serious complications.

Cited by 21 publications

References 16 publications

Colon perforation related to percutaneous nephrolithotomy: from diagnosis to treatment

Colon perforation related to percutaneous nephrolithotomy: from diagnosis to treatment

Colon perforation during percutaneous nephrolithotomy and fistula closure with Spongostan following conservative therapy

Non-contrast CT in the Evaluation of Urinary Tract Stone Obstruction and Haematuria

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