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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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Fluoroscopic image 5 minutes after fibrin glue application
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f3B-cln64_7p711: Fluoroscopic image 5 minutes after fibrin glue application


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)

Fluoroscopic image 5 minutes after fibrin glue application
© Copyright Policy
Related In: Results  -  Collection

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

f3B-cln64_7p711: Fluoroscopic image 5 minutes after fibrin glue application

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.

Show MeSH