Intestinal perforation after extracorporeal lithotripsy; Possibility of nonoperative management

Abstract

Extracorporeal Shock wave Lithotripsy (ESWL) has proved to be effective safe and nowadays is the preferred method of treatment of over 90% of upper urinary tract stones [1,2]. Nevertheless, ESWL is not devoid of complications. Although the majorities are trivial and transient, serious complications could occur but are extremely rare and only very few have been reported in the literature [3]. We report a case of small intestinal perforation following ESWL. The case is striking because we decided to carry out a non-operative management, which in this case turned out to be successful. We are not aware of another such case in the English-language literature.

Bowel Perforation after Extracorporeal Wave Lithotripsy: A Review of the Literature

“…Therefore, a surgical approach with bowel repair was required in all cases except one patient [19]. There were no fatal outcomes and clinical recovery after surgery was complete.…”

“…However, in one case it was reported that the stone was initially in the renal pelvis, where the first ESWL session was conducted [12]. Additionally, in two other cases [19,20] more previous ESWL sessions were described but it was not clearly specified if they were performed for the same stones. The interval from the procedure to the onset of symptoms varied between a few hours and 2 days, with the typical presentation being acute abdominal pain with tenderness at physical examination.…”

“…Patient's management was surgical from the beginning in 12 cases because of clinical signs of peritonitis [12][13][14]17,18,20,21,24,27]. Only in four cases [19,22,23,25] was conservative management with antibiotic initially preferred. In three of them, due to clinical worsening, patients had to undergo surgery between 24 and 48 h. In the other case [19], the patient remained hemodynamically stable and a control CT scan was performed at 7 days with signs of improvement.…”

“…While gastrointestinal damage has been described as a rare complication of ESWL, the actual incidence is unknown. Bowel perforations are uncommon, having been reported in only 16 cases in the literature to our knowledge [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27].…”