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Review
. 2015;17(3):194-201.

Treatment of Colonic Injury During Percutaneous Nephrolithotomy

Hakan Öztürk  1
Affiliations
Review

Treatment of Colonic Injury During Percutaneous Nephrolithotomy

Hakan Öztürk. Rev Urol. 2015.

Abstract

Colonic injury during percutaneous nephrolithotomy (PCNL) persists despite the advances in technical equipment and interventional radiology techniques. According to the Clavien-Dindo classification of surgical complications, colonic injury is regarded as a stage IVa complication. Currently, the rate of colonic injury ranges between 0.3% and 0.5%, with an unremarkable difference in incidence between supine and prone PCNL procedures. Colon injury is the most significant complication of PCNL. Colonic injury can result in more complicated open exploration of the abdomen, involving colostomy construction. The necessity of a second operation for the closure of the colostomy causes financial and emotional burden on the patients, patients' relatives, and surgeons. Currently, the majority of colonic injuries occurring during PCNL are retroperitoneal. The primary treatment option is a conservative approach. It must be kept in mind that the time of diagnosis is as important as the diagnosis itself in colonic injury. Surgeons performing PCNL are advised to be conservative when considering exploratory laparotomy and colostomy construction during treatment of colonic injury. We present the case of a 49-year-old woman who underwent left prone PCNL that resulted in retroperitoneal colonic injury, along with a review of the current literature.

Keywords: Clavien; Colonic injury; Complication; Management; Percutaneous nephrolithotomy; Prevention; Urolithiasis.

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Figures

Figure 1
Figure 1
(A) Preoperative computed tomography (CT) image showing coronal reconstruction (arrow: left kidney stones). (B) Preoperative CT imaging showing sagittal reconstruction (arrow: left kidney stones). (C) Preoperative CT image showing digital subtraction (arrow: stones).
Figure 2
Figure 2
(A) Postoperative abdominal radiograph (yellow arrow: free air in the abdomen; red arrow: nephrostomy tube). (B) Postoperative abdominal radiograph (arrow: left double J stent). (C) Postoperative computed tomography image showing coronal reconstruction (arrow: retroperitoneal inflammation).
See this image and copyright information in PMC

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