Management of Colon Perforation During Percutaneous Nephrolithotomy in Patients with Complex Anatomy: A Case Series

A possible novel approach to small iatrogenic colonic perforation during nephrostomy placement

Placement of a percutaneous nephrostomy (PCN), to drain and preserve renal function, is a common urologic procedure in the setting of high urinary obstruction. Colonic perforation is a rare complication, with an incidence of 0.2-0.5%. In these situations, literature advises the withdrawal of the PCN into the colon, ureteral stenting, zero-diet, broad spectrum antibiotics and only to remove the catheter days after. Here we describe the case of a patient in whom a PCN was placed transversing the colon, in whom it was retrieved under endoscopic control, with use of endoclips to control the hemorrhage and close the perforation.

[New treatment concepts for colonic injury after percutaneous nephrolithotomy]

Percutaneous nephrolithotomy (PCNL) has become the gold standard for the treatment of large kidney stones > 2 cm and stones in the lower calyces > 1.5 cm. Despite the miniaturization of instruments and the greater expertise of urologists, serious complications can still occur. One of the most dangerous complications is intestinal perforation. Current database analyses report colonic injury in 0.3-0.8% of all cases. These injuries can be treated with either conservative management with long-term drainage and parenteral nutrition, or an exploratory laparotomy with primary closure or creation of a colostomy becomes necessary. We present the case of a 53-year-old woman who underwent left-sided PCNL for a single kidney stone. After removal of the nephrostomy, feces leaked from the puncture channel. After literature research and an interdisciplinary case presentation, the decision was made in favor of an undescribed therapy concept for colon injury after PCNL. After taking laxatives, a colonoscopy was performed. The entry and exit points of the puncture were identified and were both treated with an OTSC® clip (InMedi, Langenhagen, Germany). Immediately after the intervention stool leakage via the puncture channel stopped and the patient was allowed to eat normally. A control sonography on the third day revealed minimal fluid retention in the retroperitoneum which did not require treatment. The patient was then discharged symptom-free.