Colon perforation after percutaneous nephrolithotomy revisited.

Objective was to remind the reader of a rare but nevertheless serious complication of percutaneous nephrolithotomy (PCNL) which is further complicated by the lack of pre-operative and intra-operative warning signs. A patient underwent an apparently normal PCNL. Only just before removal of the nephrostomy tube, signs of colonic perforation became apparent. In spite of no clinical signs of sepsis or shock, the patient developed severe complications during and after the ensuing surgery. Every urologist, surgeon, or radiologist performing PCNL must be aware of the risk of an aberrant retrorenal colon loop, the perforation of which will most likely not be noticed during the procedure. Abdominal symptoms of a more general nature must lead to the active exclusion of this complication. If a CT scan has been performed pre-operatively for whatever reason, attention should be paid to the juxtarenal colon. Although a CT scan can exclude a retrorenal colon, such a procedure would exceed the needs and limitations of routine evaluation in all patients for PCNL. Copyright 2004 S. Karger AG, Basel