1039 Colon perforation during percutaneous renal surgery: A ten year experience in a single endourology centre

1039 - Colon perforation during percutaneous renal surgery: A ten year experience in a si... Page 1 of 2

e1039 Colon perforation during percutaneous renal surgery: A ten year experience in a single endourology centre 1

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Kachrilas S. , Bach C. , Zaman F. , Dickens N. , Papatsoris A. , 1

Masood J. , Buchholz N. 1

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Barts and The London NHS Trust, Dept. of Endourology and Stone 2

Services, London, United Kingdom, School of Medicine, University of Athens, Sismanoglio Hospital, 2nd Department of Urology, Athens, Greece INTRODUCTION & OBJECTIVES: Colon injury during percutaneous renal surgery is rare but can result in significant morbidity. Our objectives in this study were: 1) to optimize prevention and diagnosis 2) to establish an algorithm regarding treatment strategy and outcome of such complication. MATERIAL & METHODS: All patients undergoing percutaneous renal procedures (percutaneous nephrolithotomy-PCNL and/ or percutaneous endopyelotomy) between 2001 until 2011 were studied. The patient’s files were reviewed for the complication of colonic perforation. Operative details, postoperative course, and the specific circumstances of the colonic perforations, as well as the management and outcome were analysed. RESULTS: In this ten-year period, 1620 percutaneous renal procedures were performed in our centre. Percutaneous renal access was established under fluoroscopic guidance, tract dilatation was performed with a balloon dilator. Colon perforation was recorded in 5 procedures. The diagnosis was established in one patient intraoperatively, with antegrade pyelography during the nephrostomy insertion and postoperatively in 4 patients with enhanced computer tomography or antegrade pyelography. All cases were successfully managed conservatively. This included drain insertion into the colon under X-ray guidance (retraction of nephrostomy and conversion into a

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4/7/2012

1039 - Colon perforation during percutaneous renal surgery: A ten year experience in a si... Page 2 of 2

e1039a colostomy), renal drainage with a double J and urethral catheter insertion, antibiotic cover and elemental or parenteral nutrition. No open surgery was required and all patients recovered completely. Table 1: PATIENT 1 2 AGE 33 54 SIDE Left Right SEX Male Male STONE Recurrent Recurrent NATURE STONE Staghorn Single+ Endopyelo NUMBER RENAL Normal Normal STATUS DILATATION Nephromax Nephromax SITE OF Subcostal Supracostal / supra PUNCTURE PUNCTURED Lower Lower CALIX DIAGNOSIS Postoperative Postoperative TREATMENT Conservative Conservative NUTRITION Elemental Elemental ANTIBIOTICS Ampicillin/gentamicin/metronidazole Ampicillin/gentamic USED BLOOD Not required Not required TRANSFUSION HOSPITAL Seven Nine STAY (DAYS ) CONCLUSIONS: Colon injury is a rare but serious complication of percutaneous access to the kidney. In our series it occurred in 0.3% of cases. Our results show that the conservative treatment in colon perforation is an effective and safe management and that it can be adopted in the majority of cases with excellent results.

file://F:\RamShankar\April\04-05-12\Cip\Sour\1039.html

4/7/2012