The management protocol for colon perforation during percutaneous nephrolithotomy (PNL) is controversial due to the scarcity of reported cases and their management diversity. We present our management experience of colon perforation during PNL.
All PNL operations between April 2004 and September 2016 in our center (N=11376) were reviewed for the occurrence and management of colon perforation. We typically performed PNL with insertion of nephrostomy tube before mid 2007. After mid 2007, we typically perform tubeless PNL and inspect access tract for evidence of organ injury especially colon perforation during nephroscope removal.
17 colon perforations happened during the study period. The first 3 cases were diagnosed postoperatively and in 2 patients open surgery was employed for treatment. The next 14 cases were diagnosed intraoperatively (n=12) or in the early postoperative period (n=2) and were managed by broad spectrum antibiotics, bowel rest, and urinary Dj and Foley catheter insertion. Percutaneous retroperitoneal drain was inserted for only one patient after intraoperative diagnosis of colon perforation. The other 13 patients were managed without insertion of such drains. For one patient, postoperative insertion of retroperitoneal drain was attempted due to collection of urine. In other patients (n=12), the management was successful with no need for an operation. Complications according to Clavien-Dindo grade in these 17 patients were grade II, IIIa and IIIb in 13, 1, and 3 patients respectively.
Colon perforation during PNL which is diagnosed intraoperatively or in the very early postoperative period can be managed conservatively. It seems possible not to insert colostomy or retroperitoneal drains in stable patients with early or intraoperative diagnosis. In cases of delayed diagnosis, or deterioration of the patient on tubeless management, the standard protocol should be performed including insertion of colonic or retroperitoneal drain or surgery especially in patients with signs or symptoms of peritonitis or persistent fever.
Journal of endourology. 2017 Aug 09 [Epub ahead of print]
Robab- Maghsoudi, Massoud Etemadian, Amir Hossein Kashi, Kaveh Mehravaran
Hasheminejad Kidney Center (HKC), Endourology , Vanak Squ,Valiasr Ave,Valinejhad str , Tehran, Tehran, Iran, Islamic Republic of , 1969714713., Hasheminejad Kidney Center, Urology, Tehran, Iran (the Islamic Republic of) ; ., Hasheminejad Kidney Center, Urology, Tehran, Iran (the Islamic Republic of) ; ., Hasheminejad Kidney Center (HKC), Endourology , vanak sq, valinejad st, hasheminejad hospital , Tehran, Tehran, Iran, Islamic Republic of , 81161234 ; .