Jejunal Perforation During Percutaneous Nephrolithotrypsy

Abstract

Colonic and duodenal perforations, albeit rare, are known complications of PCNL; however, to our knowledge, jejunal perforation has never been reported. We report a case of an 83-year-old man, underwent left PCNL for a 2cm stone in the renal pelvis, confirmed to have a jejunal perforation. He was successfully managed conservatively. His diagnostic work up and management will be discussed.

An unusual presentation of colon perforation following percutaneous nephrolithotomy

“…Established risk factors for colon injury during PCNL include slim body habitus, female sex, prior colon surgery, access to the left kidney at the posterior axillary line and lower pole, and most of all a retrorenal loop of colon. [4][5][6][7][8][9]15 Other than her sex (which may not be as strong a risk factor as has been suggested, given the preponderance of male patients in the existing case reports, Table 1 3,5-9, [16][17][18][19][20][21] ) and the side of her surgery, our patient had none of these risk factors, with no evidence of retrorenal colon on her preoperative CT scan. While anatomic anomalies, such as horseshoe kidney, are associated with an increased rate of retrorenal colon, 5,22 duplication of the collecting system typically does not displace the kidney from its standard anatomic location and is unlikely to be a relevant risk factor.…”

“…Two possible patterns are described: injuries that are identified radiographically immediately in or after surgery [5][6][7] and injuries that are identified in a delayed fashion due to signs of fecaluria and leukocytosis. 8,9 Our case describes an alternative delayed presentation, with symptoms of throat and chest pain, and signs of neck and shoulder crepitus with pneumomediastinum.…”

“…25,26 Recent reports describing bowel perforation during PCNL have emphasized the opportunity for non-operative management for the injury, with placement of the percutaneous nephrostomy tube into the bowel lumen to act as a drain. [5][6][7]9,27 This opportunity is predicated on the presence of an indwelling nephrostomy tube to leave as an enteric drain. Our tubeless surgery precluded this possibility.…”

Jejunal Injury as a Rare Complication of Percutaneous Nephrolithotomy: Case Report

“…Al-Assiri and colleagues reported jejunal injury during left PCNL in an 83-year-old male patient. 3 They managed this complication conservatively with favorable outcome. In our case, we suspected colonic injury and were planning for conservative management.…”

“…Nevertheless, few reports are available in the literature about small bowel injuries, including ileum 2 and jejunum. 3 Herein, we report about rarely observed jejunal injury during PCNL that progressed as acute peritonitis and required laparotomy. In addition, we tried to explain the mechanism of this injury and reviewed the literature about this rare complication and its management.…”