Colon Perforations Related to PCNL in a Tertiary Center - a Retrospective Study.

Introduction and Objectives. Percutaneous nephrolithotomy (PCNL) successfully replaced open surgery more than 30 years ago, and it still represents the gold standard in the treatment of large renal stones. Although nowadays, with advancing technology improving many technical aspects, it is considered a safe procedure with a low complication rate, close postoperative management is mandatory. Colon perforation is a rare but severe complication that can occur in specific cases. Materials and Methods. We analyzed 1146 cases, from June 2015 to May 2017, admitted in "Prof. Dr. Th. Burghele" Clinical Hospital based on medical records identified when searching procedure code. Data referring to risk factors such as age, sex, stone location and type, associated diseases, previous surgical history, and also intra and postoperative details were carefully analysed. All of the cases were primarily assessed with complete blood and urine tests. When diagnosed, urinary tract infections were treated with specific antibiotic agents. All available imagistic details were studied before and after the PCNL session for selected cases. Results. 7 cases met our criteria and were diagnosed with colonic injury after PCNL. All suspected cases were assessed imagistically with an abdominal CT scan and managed conservatively as the first intention. Sex distribution revealed five males and two females with a mean age of 52.3 years old. Colonic injuries were diagnosed intra or postoperatively and were most prevalent on the left side. Accessing the pylocaliceal system was performed by puncturing the lower calyx in 6 cases and the middle calyx for technical reasons in one case. When referring to risk factors, a retrorenal colon was diagnosed in two cases. In one case with previous open renal surgery, the right colon was injured. It was only one case of intraperitoneal lesion in which surgical management with temporary colostomy for three months was preferred. Conclusions. Colon perforation is a rare complication related to PCNL with management key being based on early diagnosis. According to other studies, our results reveal that extraperitoneal colon perforations can be successfully managed conservatively, but surgery with a temporary colostomy is the election treatment for intraperitoneal lesions. [ABSTRACT FROM AUTHOR]