Kurz W, Klein B, Rumstadt B
Urologische Klinik am Diakoniekrankenhaus Mannheim.
Dtsch Med Wochenschr. 2009 Feb;134(9):401-3. doi: 10.1055/s-0028-1124012. Epub 2009 Feb 17.
A 40-year-old man had undergone extracorporeal shock wave lithotripsy (ESWL) due to left sided urinary lithiasis. 20 hours later he presented with left lower quadrant abdominal pain.
Ultrasound examination revealed free intraabdominal air and free perisplenic fluid. An injury of the left kidney could be excluded.
Due to increasing abdominal pain a laparoscopy was performed, revealing a faecal peritonitis. Since no perforation could be detected laroscopically, a laparotomy was performed, demonstrating a perforation of the descending colon. The perforation was oversewn, a defunctioning colostomy was not performed. Postoperatively the patient had an uncomplicated hospital stay and was discharged home on postoperative day 8.
ESWL is considered a safe method to treat urinary lithiasis with a low complication rate. Nevertheless serious potentially life-threatening pararenal complications can occur. Due to the increasing number of outpatient procedures, a careful clinical and ultrasound monitoring of the patient with early recognition and interdisciplinary management of complications is necessary after each ESWL therapy.
