Diagnosis and management of small intestinal injury due to percutaneous renal access

Abstract

Purpose: Define factors for proper diagnosis and treatment of small intestinal injury during procedures with percutaneous renal access, thus optimizing favorable outcomes and avoiding complications and death during conservative or surgical approaches.

Materials and methods: Bibliographic review of case reports available in the literature and presentation of data from an additional case have been carried out.

Results: Percutaneous nephrolithotripsy was the procedure that most frequently caused injury of the small intestine. Time for diagnosis of the lesion took up to 5 days after the intraoperative phase. When occurring in the intraoperative phase, perforation was identified by direct endoscopic visualization; a catheter was then placed inside the intestinal lumen and a conservative approach to the derived fistula was adopted, which led to successful outcomes in all cases. Abdominal pain was the most common symptom in cases diagnosed during the postoperative phase (75%). In the presence of signs of peritonitis, surgical intervention was performed, with favorable evolution in all cases.

Conclusions: Conservative management of small intestine injuries is possible when there is no peritoneal contamination. Its success factors include intraoperative diagnosis and non-transfixing lesions, which is more common in duodenal involvement. Laparotomy to clean the cavity associated with a corrective approach (enterorrhaphy or enterectomy with primary anastomosis) was successfully indicated in cases of late diagnosis with signs of peritonitis, a situation that is most commonly found in transfixing lesions of ileum and jejunum.

Keywords: Intestinal complications; Jejunal perforation; Percutaneous nephrolithotomy; Percutaneous renal surgery; Small bowel perforation.