Management of a Colon Perforation During Pediatric Percutaneous Nephrolithotomy

Abstract

Percutaneous nephrolithotomy (PCNL) is one of the most common treatment options in the management of kidney stones in children. While colon perforation during PCNL is reported as a rare complication in adults, there are scarce data regarding colon perforation during pediatric PCNL. We report the successful management of colon perforation occurring during PCNL and of a renal stone in a 6-year-old child. Moreover, we describe the procedure to be followed for colon perforation in children.

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.…”

Percutaneous Nephrolithotomy and Retrorenal Colon: Its Incidence and Complications

“…Moreover, 3D CT can provide excellent representation of kidney anatomy and be used while planning a PCNL intervention; however, it does not show the relationship between the calices and different organs, such as the colon in particular and kidney motion. (20) Intraoperatively, the visualization of fecal material during nephroscopy or a bowel opacification with nephrostogram is a sign of colon injury.…”

Injury of the ileum during percutaneous nephrolithotomy in a pediatric patient

“…5 In pediatric patients, a case report of colonic injury during PCNL has been recently published. 6 This case report describes an extremely rare complication. To the best of our knowledge, this is the first case reports of ileum injury during PCNL in a pediatric patient.…”