Emergency departments (EDs) are gateways for patients presenting after minor surgical procedures, particularly shockwave lithotripsy. Complications include renal and extrarenal tissue injuries, with the latter having potentially serious consequences if not detected early.
We describe a 70-year-old male presenting to the ED for syncope. The patient underwent shockwave lithotripsy (SWL) for left kidney stones 1 day prior. Upon initial evaluation, the patient had normal vital signs and a normal physical examination, without complaints of abdominal pain. Close observation and regular patient re-evaluation led to the diagnosis of life-threatening injuries that included splenic rupture. Although this is a rare complication of SWL, with only eight published cases found in the literature, the patient's initial presentation of syncope without complaints of abdominal pain presented a unique diagnostic challenge. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be knowledgeable of the pre-existing conditions linked to higher rates of complications after shockwave lithotripsy and be able to identify and manage these potentially life-threatening complications.
The Journal of emergency medicine. 2017 Apr 10 [Epub ahead of print]
David Zodda, Meta Haley, Rocky Sayegh
Hackensack University Medical Center, Hackensack, New Jersey.