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Percutaneous injection of fibrin glue resolves persistent nephrocutaneous fistula complicating colonic perforation after percutaneous nephrolithotripsy.

Miranda EP, Ribeiro GP, Almeida DC, Scafuri AG - Clinics (Sao Paulo) (2009)

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Colonic perforation (CP) is an extremely rare complication of percutaneous nephrolithotrypsy (PCNL). ¹ Nephrocutaneous fistulas after PCNL are unusual... Typically, they resolve with conservative measures such as observation, ureteral stenting, and, occasionally, percutaneous drainage. ² We present a case of nephrocutaneous fistula as a result of a CP after PCNL that was treated with percutaneous injection of fibrin glue... Computed tomography (CT) of the upper abdomen revealed the presence of contrast in the peritoneal cavity, causing us to suspect colonic perforation secondary to PCNL... We started the patient on antibiotics and relocated the nephrostomy tube, but symptoms failed to improve, so the patient was sent to the operating room... The diagnosis includes multiple symptoms and signs that occur immediately or several days after the procedure... Unrecognized colonic injury can result in abscess formation, nephrocolic or colocutaneous fistulae, peritonitis, or sepsis... The first step after diagnosing CP is separating the nephrocolic communication, including urinary drainage with the indwelling double-J stent and removal of the nephrostomy tube from the pelvicalicial system... Conservative treatment is usually successful in patients with early-diagnosed retroperitoneal colonic injury; however, late diagnosis can result in colostomy... Urine leaks can also require percutaneous drainage or surgical correction... Nephrocutaneous fistula after PCNL is usually managed successfully with observation... Because our case consisted of an elderly patient complicating with a CP, who required a recent course of antibiotics, we thought that the administration of fibrin glue would result in prompt closure of the urine leak and provide faster relief to our patient... Fibrin glue application not only prevents the necessity of more invasive surgical correction of persistent nephrocutaneous fistulas but also represents a good initial strategy for selected cases... The optimal results we obtained and the absence of reported complications in urologic procedures lead us to recommend this therapeutic option for extensive use.

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Fibrin glue applicator being placed through the catheter
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f2-cln64_7p711: Fibrin glue applicator being placed through the catheter

Mentions: The patient was once more taken to the operating room, and a retrograde ureteropyelography was performed, revealing an 8-mm diameter nephrocutaneous fistula (Figure 1). A guide wire was placed through the fistula under fluoroscopic guidance. A 6.5-F catheter was advanced over the wire to the level of the kidney sheath, and a flexible fibrin glue applicator was placed through the catheter (figure 2). Approximately 5 ml of fibrin glue was injected throughout the fistula tract as the catheter was slowly withdrawn. A control fluoroscopic image was obtained (Figure 3), revealing the absence of further communication between the renal sheath and the skin. On the first postoperative day, no urinary leakage was observed; at a four-week follow-up, the patient was asymptomatic with unremarkable findings at clinical examination. At this time, the double-J catheter was withdrawn, and no urinary leakage was seen after that.


Percutaneous injection of fibrin glue resolves persistent nephrocutaneous fistula complicating colonic perforation after percutaneous nephrolithotripsy.

Miranda EP, Ribeiro GP, Almeida DC, Scafuri AG - Clinics (Sao Paulo) (2009)

Fibrin glue applicator being placed through the catheter
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2710447&req=5

f2-cln64_7p711: Fibrin glue applicator being placed through the catheter
Mentions: The patient was once more taken to the operating room, and a retrograde ureteropyelography was performed, revealing an 8-mm diameter nephrocutaneous fistula (Figure 1). A guide wire was placed through the fistula under fluoroscopic guidance. A 6.5-F catheter was advanced over the wire to the level of the kidney sheath, and a flexible fibrin glue applicator was placed through the catheter (figure 2). Approximately 5 ml of fibrin glue was injected throughout the fistula tract as the catheter was slowly withdrawn. A control fluoroscopic image was obtained (Figure 3), revealing the absence of further communication between the renal sheath and the skin. On the first postoperative day, no urinary leakage was observed; at a four-week follow-up, the patient was asymptomatic with unremarkable findings at clinical examination. At this time, the double-J catheter was withdrawn, and no urinary leakage was seen after that.

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Colonic perforation (CP) is an extremely rare complication of percutaneous nephrolithotrypsy (PCNL). ¹ Nephrocutaneous fistulas after PCNL are unusual... Typically, they resolve with conservative measures such as observation, ureteral stenting, and, occasionally, percutaneous drainage. ² We present a case of nephrocutaneous fistula as a result of a CP after PCNL that was treated with percutaneous injection of fibrin glue... Computed tomography (CT) of the upper abdomen revealed the presence of contrast in the peritoneal cavity, causing us to suspect colonic perforation secondary to PCNL... We started the patient on antibiotics and relocated the nephrostomy tube, but symptoms failed to improve, so the patient was sent to the operating room... The diagnosis includes multiple symptoms and signs that occur immediately or several days after the procedure... Unrecognized colonic injury can result in abscess formation, nephrocolic or colocutaneous fistulae, peritonitis, or sepsis... The first step after diagnosing CP is separating the nephrocolic communication, including urinary drainage with the indwelling double-J stent and removal of the nephrostomy tube from the pelvicalicial system... Conservative treatment is usually successful in patients with early-diagnosed retroperitoneal colonic injury; however, late diagnosis can result in colostomy... Urine leaks can also require percutaneous drainage or surgical correction... Nephrocutaneous fistula after PCNL is usually managed successfully with observation... Because our case consisted of an elderly patient complicating with a CP, who required a recent course of antibiotics, we thought that the administration of fibrin glue would result in prompt closure of the urine leak and provide faster relief to our patient... Fibrin glue application not only prevents the necessity of more invasive surgical correction of persistent nephrocutaneous fistulas but also represents a good initial strategy for selected cases... The optimal results we obtained and the absence of reported complications in urologic procedures lead us to recommend this therapeutic option for extensive use.

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