Colon injury during percutaneous nephrolithotomy (clinical case, literature review)

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Abstract

Urolithiasis occupies one of the leading places in terms of the frequency of requests for urgent urological care and emergency hospitalization in specialized departments. Percutaneous surgery for urolithiasis, like any of the surgical methods, is associated with a number of specific and non-specific complications. Of course, the frequency of occurrence is dominated by hemorrhagic and inflammatory complications. But damage to the colon is quite rare and amounts to 0.3–0.4%.

Focusing on the literature data, it is possible to identify risk factors for colon damage and clinical manifestations of this complication. Given the small clinical experience, both in the world and in the domestic literature, there is no recommendatory base for the management of patients with colon damage during percutaneous interventions. Publications available for analysis indicate the possibility of both an operative approach with the removal of a colostomy and conservative management of patients with such complications.

The article presents a clinical observation of successful conservative management of a patient with damage to the descending colon during percutaneous nephrolithotomy. An assessment of risk factors for colon damage in this patient was given. Imaging methods are presented that confirm the presence of this complication and the resulting recovery during the follow-up examination.

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About the authors

S. V. Shkodkin

FSAEI HPE «Belgorod State National Research University»; Belgorod regional clinical hospital Saint Ioasaf

Author for correspondence.
Email: shkodkin-s@mail.ru

Dr.Med.Sci., professor of the Medical Institute Federal State Autonomous Educational Institution of Higher Education «Belgorod National Research University», doctor urologist, Belgorod Regional Clinical Hospital of Svyatitelya Ioasafa

Russian Federation, Belgorod; Belgorod

Y. B. Idashkin

Belgorod regional clinical hospital Saint Ioasaf

Email: shkodkin-s@mail.ru

doctor urologist, Belgorod regional clinical hospital Svyatitelya Ioasafa

Russian Federation, Belgorod

M.Z. A.A. Zubaydi

FSAEI HPE «Belgorod State National Research University»

Email: zubaydi@mail.ru

post-graduate student, Department of Hospital Surgery Professor of the Medical Institute Federal State Autonomous Educational Institution of Higher Education «Belgorod National Research University»

Russian Federation, Belgorod

A. F. Huseynzoda

FSAEI HPE «Belgorod State National Research University»

Email: husenzoda.abdullo@mail.ru

post-graduate student, Department of Hospital Surgery Professor of the Medical Institute Federal State Autonomous Educational Institution of Higher Education «Belgorod National Research University»

Russian Federation, Belgorod

J. K. Askari

FSAEI HPE «Belgorod State National Research University»

Email: dr_askari@mail.ru

post-graduate student, Department of Hospital Surgery Professor of the Medical Institute Federal State Autonomous Educational Institution of Higher Education «Belgorod National Research University»

Russian Federation, Belgorod

E. G. Ponomarev

FSAEI HPE «Belgorod State National Research University»

Email: dr.ponomarev95@mail.ru

post-graduate student, Department of Hospital Surgery Professor of the Medical Institute Federal State Autonomous Educational Institution of Higher Education «Belgorod National Research University»

Russian Federation, Belgorod

V. Y. Nechiporenko

FSAEI HPE «Belgorod State National Research University»

Email: nechnik1819@mail.ru

post-graduate student, Department of Hospital Surgery Professor of the Medical Institute Federal State Autonomous Educational Institution of Higher Education «Belgorod National Research University»

Russian Federation, Belgorod

K. S. Shkodkin

FSAEI HPE «Belgorod State National Research University»

Email: kirill_shkodkin@mail.ru

post-graduate student, Department of Hospital Surgery Professor of the Medical Institute Federal State Autonomous Educational Institution of Higher Education «Belgorod National Research University»

Russian Federation, Belgorod

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Supplementary files

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2. Fig 1. Retrorenally located colon: A - on the right (link to online publication: https://www.google.com/url?sa=i&url=https%3A%2F%2F link.springer.com%2Fchapter%2F10.1007%2F978-l-4419- 5939-3_6&psig=AOvVVawOhySONQ5flP8C4GqKaqu4m& ust=1671182939051000&source=images&cd=vfe&ved=0C BAQjRxqFwoTCPiDrN2n-_sCFQAAAAAdAAAAAAAAABAF) B - on the left (link to online publication: https://www.google.com/url?sa=i&url=https%3A%2F%2F twitter.com%2Fguidogiusti%2Fstatus%2F10175495973786 00961%3Flang%3Dhe&psig=AOvVaw0I3uMEJlMH7B4Qr Xh9qMnP&ust=1671183161128000&source=images&cd= vfe&ved=0CA8QjRxqFwoTCJia68ao-_sCFQQAAAAAAAAAdAAA AAABAQ)

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3. Fig 2. CBCT data of patient B: A - coronal projection: 1 - paraneurium (highlighted in yellow), 2 - signs of scoliosis, 3 - colon adjacent to the lower pole; B - axial scan at the level of the upper calyx of the left kidney; C - axial scan at the level of the middle calyx of the left kidney; D - axial scan at the level of the lower calyx of the left kidney (explanations in the text).

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4. Fig 3. Patient B. 46 years old: A - endoscopic picture of percutaneous nephrolithotomy on the left side; B - projection skeletotopy of the left kidney and percutaneous access after nephrostomy removal (3rd day after percutaneous intervention).

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5. Fig. 4. CBCT data (native phase) of patient B. 46 years old with a wound of the descending colon during percutaneous nephrolithotomy on the left: Gas in the urinary tract is highlighted in red color: A - axial projection at the level of the renal sinus on the left; B - axial projection at the level of the bladder; C - coronal projection at the level of the left kidney CSF; D - sagittal projection at the level of the left ureter.

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6. Fig. 5. CBCT data (excretory phase) of patient B. 46 years old with a wound of the descending colon during percutaneous nephrolithotomy on the left side: A - axial projection; B - coronal projection; C - sagittal projection; D - 3D-reconstruction. 1 - contrast in the lumen of the colon. 2 - renal-intestinal fistula.

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7. Fig. 6. "Marsupitalization" percutaneous access (3rd day after percutaneous intervention)

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8. Fig. 7. CT data (excretory phase, ZD-reconstruction) of patient B. 46 years old with a wound of the descending colon during percutaneous nephrolithotomy on the left side 2 months after surgery No extravasation of contrast and gas in the CSF.

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