Duodenal perforation and a broken guidewire fragment inside the duodenum during supine percutaneous nephrolithotomy (PCNL) without adequate prior imaging: A case report

Dahril, Dahril; Oetama, Harris; Mustafa, Akhmad

doi:10.1016/j.eucr.2018.10.007

Cited by 5 publications

(4 citation statements)

References 6 publications

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“…This specific study by Roberson N et al published in 2018 studied 69 patients and reported ultrasound to have high specificity but moderate sensitivity with reported false negatives. 19 Relating to paediatric patients, CT provides an excellent diagnostic modality to provide all the above-mentioned parameters before proceeding with an intervention 20,21 . Especially, PCNL requires eliciting delineation of renal anatomy before proceeding.…”

Section: Discussionmentioning

confidence: 99%

Assessment of CT-KUB as A Diagnostic Tool for Renal Stone Assessment in the Pediatric Population

Ali,

Azad

2024

biosight

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Introduction Pakistan possesses a larger stone burden in paediatric patients. In the paediatric population, proper and timely diagnosis of renal stones to get the best stone-free rates is essential. This study aims to assess CT-KUB as a diagnostic tool for renal stones in the paediatric population before PCNL. Methodology This is a retrospective, cross-sectional study. Patients between 1 – 15 years with a diagnosis of renal stones were included in the study. Radiological investigations including Ultrasound KUB, X-ray KUB, and before the procedure, CT-KUB were documented. Pre-operative, per-operative, and postoperative complications are used to assess the success of the procedure. The statistical package of Social Sciences 22 was used to enter, sort, and analyze the data. Variables were analyzed in mean ± standard deviation and frequency and percentages. The chi-square test was used to assess the significance of mean differences keeping the p-value as ≤ 0.05. Results The mean age was 4.7 ± 3.8 years with a range of 1 -14 years. After the procedure, 104 (86.6%) were rendered stone-free after the first setting. Only 1 (0.8%) was converted to an open case (Pyelolithotomy). The mean stone size encountered was 1.3 ± 0.7 cm in greatest dimension as measured on the CT scan. Postoperatively, there was a hemoglobin drop of 2.3 ± 0.5 g/dl noted, mean operative time was 94.8 ± 17.4 minutes. Conclusion CT KUB proves to be an important and accurate preoperative diagnostic tool in assessing patients with renal stones in the paediatric population.

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Section: Discussionmentioning

confidence: 99%

Assessment of CT-KUB as A Diagnostic Tool for Renal Stone Assessment in the Pediatric Population

Ali,

Azad

2024

biosight

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“…As a matter of fact, the following postoperative course was finally uneventful. In literature, a very limited number of cases of iatrogenic injury of the duodenum during endourologic surgery were found: one in a patient with an indwelling right ureteral DJ stent [16] and 4 cases of duodenal perforation during percutaneous nephrolithotomy [17].…”

Section: Discussionmentioning

confidence: 99%

A case of duodenal perforation and pancreatic bleeding after flexible ureteroscopy for right renal pelvis UTUC

Spagna,

OO,

Proietti

et al. 2023

UTJ

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Upper tract urothelial carcinoma (UTUC) can be managed by flexible ureteroscopy (f-URS) and tumor laser ablation if kidney-sparing surgery is possible. This procedure can be affected by minor to serious complications, including life-threatening sepsis, ureteral strictures, and ureteral and renal pelvis injuries. The case of a 53-year-old man with history of high grade right renal pelvis and bladder tumor who undergone multiple endoscopic treatments and has already refused radical surgery is reported. F-URS and laser ablation with Thulium: YAG laser for UTUC recurrence of the right renal pelvis was performed, but the procedure was stopped due to significant bleeding which impaired vision. Postoperatively, the patient developed hematemesis and hemodynamic instability due to duodenal lesion and active bleeding documented at CT scan. An emergency exploratory laparotomy was performed to drain hemoperitoneum, repair duodenal lesion and concurrent radical right nephroureterectomy was carried out. A second surgery was necessary for repairing duodenal fistula. After 1 week the patient presented again with recurrent hematemesis and hemorrhagic shock. He underwent angiography and selective embolization of the duodenal branch of superior mesenteric artery and as well as branches of gastroduodenal artery successfully and the patient recovered with no other complications. This is the first case of duodenal perforation and pancreatic bleeding due to flexible ureteroscopy and laser ablation of right renal pelvis urothelial carcinoma.

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“…Percutaneous renal procedures associated with damage to the gastrointestinal tract are extremely rare and most often seen in the colon. Only five cases of duodenal damage Case Reports in Urology associated with percutaneous procedures have been reported so far [7]. Moreover, all of them were specifically associated with percutaneous nephrolithotomy (PCNL), but one.…”

Section: Discussionmentioning

confidence: 99%

“…With the present case, there are only two and four cases of duodenal injury after PCN and PCNL procedures, respectively, in the urological literature. Previous three cases associated with PCNL were managed with conservative approaches such as perinephric drainage, nasogastric tube, H2 antagonist, and total parenteral nutrition, whereas the other one was treated with laparotomy and primary suture repair [7]. The first case after PCN was similarly managed with open repair of the duodenal perforation [3].…”

Section: Discussionmentioning

confidence: 99%

Conservative Management of the Duodenal Injury during Percutaneous Nephrostomy Placement: A Few and Far between Complications of the Urological Literature

Colakerol

Temiz

Adem

et al. 2021

Case Reports in Urology

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Herein, we reported a duodenal perforation case as an intestinal injury during a percutaneous nephrostomy procedure. A 73-year-old woman with bilateral nephrostomy catheters was applied to the emergency service with right flank pain. Early in the day, her bilateral nephrostomy catheters had been changed. On physical examination, she had a defense and rebound at her right quadrant, and costovertebral angle tenderness was also positive. In the contrast-enhanced abdominal computed tomography scan, the right nephrostomy catheter was located in the second part of the duodenum, and the contrast agent did not leak into the peritoneum from the injury area. We decided on conservative management of the case with active surveillance using daily blood tests and physical examinations. The nephrostomy catheter in the duodenum was left to prevent fistula between the duodenum and the skin, and a new one was placed in the right kidney. The broad spectrum antibiotherapy regime was applied, and the patient was followed up closely. The catheter in the duodenum was removed on the 20th day, uneventfully, and the patient was discharged successfully on the 24th day with her permanent bilateral nephrostomy tubes. On the first follow-up, one month later, the patient had no active medical complaint.

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Duodenal perforation and a broken guidewire fragment inside the duodenum during supine percutaneous nephrolithotomy (PCNL) without adequate prior imaging: A case report

Cited by 5 publications

References 6 publications

Assessment of CT-KUB as A Diagnostic Tool for Renal Stone Assessment in the Pediatric Population

Assessment of CT-KUB as A Diagnostic Tool for Renal Stone Assessment in the Pediatric Population

A case of duodenal perforation and pancreatic bleeding after flexible ureteroscopy for right renal pelvis UTUC

Conservative Management of the Duodenal Injury during Percutaneous Nephrostomy Placement: A Few and Far between Complications of the Urological Literature

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