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Minimally invasive management of biliary tract injury following percutaneous nephrolithotomy.

Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, Cohen JH, Naghshizadian I, Gilchrist BF, Farkas DT - Nephrourol Mon (2014)

Bottom Line: Percutaneous nephrolithotomy is generally considered a safe option for the management of large complex or infectious upper urinary tract calculi.The patient was discharged home shortly thereafter, and the tube was later removed at a follow up visit after a normal cholangiogram.Ideally this can be done with ERCP and a stent, but in cases where this is not technically feasible; a percutaneous cholecystostomy can be successful at accomplishing the same result.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, New York, USA.

ABSTRACT

Introduction: Percutaneous nephrolithotomy is generally considered a safe option for the management of large complex or infectious upper urinary tract calculi. Biliary tract injury is a rare and potentially serious complication of percutaneous nephrolithotomy that can even lead to mortality, especially in cases where biliary peritonitis develops. All reported cases of biliary tract injury have been managed by either open or laparoscopic cholecystectomy.

Case presentation: Herein for the first time, we report a 39-year old woman with biliary tract injury following percutaneous nephrolithotomy who was managed less invasively by insertion of a percutaneous cholecystostomy tube. The patient was discharged home shortly thereafter, and the tube was later removed at a follow up visit after a normal cholangiogram.

Conclusions: Biliary tract injury is a rare and potentially serious complication of percutaneous nephrolithotomy that can even lead to mortality. If a biliary tract injury is suspected during percutaneous renal procedures, diverting the bile away from the leak may resolve the problem without the need for a cholecystectomy. Ideally this can be done with ERCP and a stent, but in cases where this is not technically feasible; a percutaneous cholecystostomy can be successful at accomplishing the same result.

No MeSH data available.


Related in: MedlinePlus

Abdominal CT Scan After Attempted Percutaneous Nephrolithotomy Showing Large Amount of Fluid Collection in Peri-Hepatic and Peri-Nephric Area
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fig13235: Abdominal CT Scan After Attempted Percutaneous Nephrolithotomy Showing Large Amount of Fluid Collection in Peri-Hepatic and Peri-Nephric Area

Mentions: A 39-year old woman, with past medical history of gastric bypass, was scheduled to undergo percutaneous nephrolithotomy (PCNL) for a 4 cm right renal pelvic calculus with partial staghorn extension to lower pole. At the time of passage of an 18-gauge needle to the right kidney under fluoroscopy guidance, bile stained fluid was aspirated and the procedure aborted. A large caliber ureteral stent and Foley catheter were placed to maximize urinary drainage and the patient admitted for observation. Overnight, the patient developed abdominal pain and became tachycardic and tachypenic. Laboratory studies showed an increased white cell count (19.9 × 103 per microliter), while liver function tests stayed in normal range with total and direct bilirubin 0.6 mg/dL (0.2-1.3) and 0.2 mg/dL (0-0.4) respectively. Subsequently abdominal CT scan was performed which showed a large fluid collection in the right peri-hepatic and peri-nephric area (Figure 1). Interventional radiology was consulted to place a sub-hepatic drain.


Minimally invasive management of biliary tract injury following percutaneous nephrolithotomy.

Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, Cohen JH, Naghshizadian I, Gilchrist BF, Farkas DT - Nephrourol Mon (2014)

Abdominal CT Scan After Attempted Percutaneous Nephrolithotomy Showing Large Amount of Fluid Collection in Peri-Hepatic and Peri-Nephric Area
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4318014&req=5

fig13235: Abdominal CT Scan After Attempted Percutaneous Nephrolithotomy Showing Large Amount of Fluid Collection in Peri-Hepatic and Peri-Nephric Area
Mentions: A 39-year old woman, with past medical history of gastric bypass, was scheduled to undergo percutaneous nephrolithotomy (PCNL) for a 4 cm right renal pelvic calculus with partial staghorn extension to lower pole. At the time of passage of an 18-gauge needle to the right kidney under fluoroscopy guidance, bile stained fluid was aspirated and the procedure aborted. A large caliber ureteral stent and Foley catheter were placed to maximize urinary drainage and the patient admitted for observation. Overnight, the patient developed abdominal pain and became tachycardic and tachypenic. Laboratory studies showed an increased white cell count (19.9 × 103 per microliter), while liver function tests stayed in normal range with total and direct bilirubin 0.6 mg/dL (0.2-1.3) and 0.2 mg/dL (0-0.4) respectively. Subsequently abdominal CT scan was performed which showed a large fluid collection in the right peri-hepatic and peri-nephric area (Figure 1). Interventional radiology was consulted to place a sub-hepatic drain.

Bottom Line: Percutaneous nephrolithotomy is generally considered a safe option for the management of large complex or infectious upper urinary tract calculi.The patient was discharged home shortly thereafter, and the tube was later removed at a follow up visit after a normal cholangiogram.Ideally this can be done with ERCP and a stent, but in cases where this is not technically feasible; a percutaneous cholecystostomy can be successful at accomplishing the same result.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, New York, USA.

ABSTRACT

Introduction: Percutaneous nephrolithotomy is generally considered a safe option for the management of large complex or infectious upper urinary tract calculi. Biliary tract injury is a rare and potentially serious complication of percutaneous nephrolithotomy that can even lead to mortality, especially in cases where biliary peritonitis develops. All reported cases of biliary tract injury have been managed by either open or laparoscopic cholecystectomy.

Case presentation: Herein for the first time, we report a 39-year old woman with biliary tract injury following percutaneous nephrolithotomy who was managed less invasively by insertion of a percutaneous cholecystostomy tube. The patient was discharged home shortly thereafter, and the tube was later removed at a follow up visit after a normal cholangiogram.

Conclusions: Biliary tract injury is a rare and potentially serious complication of percutaneous nephrolithotomy that can even lead to mortality. If a biliary tract injury is suspected during percutaneous renal procedures, diverting the bile away from the leak may resolve the problem without the need for a cholecystectomy. Ideally this can be done with ERCP and a stent, but in cases where this is not technically feasible; a percutaneous cholecystostomy can be successful at accomplishing the same result.

No MeSH data available.


Related in: MedlinePlus