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- Title
Management of Colon Perforation Following Percutaneous Nephrolithotomy.
- Authors
Porav-Hodade, D.; Balan, D.; Ghirca, V. M.; Vartolomei, M. D.; Martha, O.; Todea, C.
- Abstract
Introduction and Objectives. In the EAU guidelines the percutaneous nephrolithotomy (PCNL) is the main indication for kidney stones with dimensions over 2 cm. Early recognition of the colonic perforation an important step in limiting an infection that can lead to subsequent sequelae The objectives of this study is to evaluate the cases in which colonic perforation has occurred, both in terms of possible favoring factors and from the perspective of the treatment applied and of the subsequent evolution of the patient. Material and Methods. Between January 2009 and January 2019 we performed 1394 PCNL interventions. All patients were operated in prone position. We analyzed the cases in which the colonic perforation appeared. Positive diagnosis was made after computerized tomography. We took into account the patients' age, sex, previous surgical history, body mass index, time to diagnosis of colonic perforation, type of treatment applied in this complication, length of hospitalization as well as case evaluation at 6 weeks and 6 months, respectively. Results. Of the 1394 patients in whom we performed PCNL, colonic perforation appeared in 4 of them, all female patients. A conservative treatment was applied to all patients. In patients with colonic fistula on the left side, healing was done without complications. In the patient with colonic fistula on the right side at 4 days postoperatively, surgery was required which resulted in the right colectomy. The ureteral stent was suppressed in all patients 6 weeks after discharge. The control at 6 weeks and at 6 months revealed a kidney without lithiasis, sterile urine culture or sequelae of the colonic fistula. Conclusion. Colon perforation is a severe complication after PCNL. Factors favoring these complications should be recognized preoperatively and thus the risk of colonic perforation can be reduced. Conservative treatment can be applied especially in cases where colonic perforation occurs following a PCNL performed on the left side.
- Subjects
UGANDA; PERCUTANEOUS nephrolithotomy; SURGICAL stents; COMPUTED tomography; COLON (Anatomy); COLECTOMY; BRONCHIAL fistula; TYMPANIC membrane perforation
- Publication
Romanian Journal of Urology, 2019, Vol 18, Issue 4, p26
- ISSN
1223-0650
- Publication type
Article