Colonic perforation in a child during percutaneous nephrolithotomy and its management

Abstract

Colonic perforation during percutaneous nephrolithotomy (PCNL) is a rare complication and has not been reported in the pediatric literature. Conservative management is sufficient in most cases since the colonic trauma is retroperitoneal. A five-year-old girl underwent simultaneous bilateral PCNL for bilateral kidney stones. No anatomical variation was found on preoperative radiologic examination. After removal of the stone in the right kidney, an access sheath was introduced to the lower pole of the left kidney and a guide wire was inserted. When sufficient dilatation was obtained, it was noted that the guide wire was displaced and perforated the descending colon. After completion of stone removal in the left kidney, a 12F Nelaton catheter was inserted over the guide wire for controlled fistulization of the colon defect. Antibiotic therapy was instituted postoperatively and oral feeding was started after 48 hours during which time no complication was observed. The drainage catheter was removed gradually from 10 to 14 days postoperatively. The patient was discharged with placement of an urostomy pouch at the site of the fistula. One week later, the pouch was removed upon observation of no drainage and near closure of the fistula. Two weeks later, complete closure was obtained. The patient had no urological or gastroenterological complaints during a two-month follow-up.