Colonic perforation during percutaneous nephrolithotomy: can we predict it

Abstract

Background: Colonic perforation though rare but is one of the most dangerous complications of Percutaneous nephrolithotomy (PCNL) which may lead to increase significant post operative morbidity in worldwide, therefore, the aim of this study was to explore colonic perforation during percutaneous nephrolithotomy- Can we predict it.Methods: We reviewed retrospectively the data of 1270 PCNL procedures performed between April 2013 and April 2019 at Ayushyaman kidney hospital, Palanpur, North Gujarat, India. All parameters including demography, history, stone parameters, site of skin puncture and punctured calyx, were reviewed in all these patients.Results: Colonic perforation was found in 10 patients (7 males and 3 females) and the mean age was 40.5±20.0. The left side was affected in 4 patients and the right side was injured in 6 cases. Conservative administration was the treatment planned for all patients. It included withdrawal of the nephrostomy tube outside the kidney to the colon as a percutaneous colostomy, insertion of a double-J ureteral stent, intravenous broad-spectrum antibiotics, bowel rest and total parenteral nutrition. Under this conservative management, entire healing of the colon was achieved in all cases.Conclusions: Colonic perforation is rare complication in PCNL. High degree of suspicion, early diagnosis and timely management can prevent sepsis and peritonitis and minimize patient morbidity and mortality.