Ding Xiaobo, Guan Jingjing, Tian Jingyan, Hou Yuchuan, Wang Chunxi, Wang Yanbo
1 Department of Radiology, First Hospital of Jilin University, Changchun, China.
2 Department of Urology, First Hospital of Jilin University, Changchun, China.
J Int Med Res. 2018 Oct;46(10):4350-4353. doi: 10.1177/0300060518791704. Epub 2018 Aug 20.
Postoperative bleeding is a dangerous complication after percutaneous nephrolithotomy (PCNL). Pseudoaneurysm, arteriovenous fistula, and arterial laceration are the three most common causes of post-PCNL bleeding. Subcostal artery bleeding is a rare cause. We herein present a clinical case involving a 43-year-old man who presented with right renal complex calculi and was managed by PCNL in the prone position using an inferior calyceal puncture approach. Intermittent extreme bleeding occurred 1 day postoperatively, and immediate renal angiography was performed. However, we found no sign of a pseudoaneurysm, arteriovenous fistula, or arterial laceration. Another well-trained and experienced doctor also found no pseudoaneurysm, arteriovenous fistula, or arterial laceration. After adjusting the catheter position, subcostal artery bleeding finally appeared and was successfully controlled by coils. This finding indicates that subcostal artery damage is one cause of post-PCNL bleeding. We suggest that clinicians should carefully and patiently perform angiography and/or embolization to avoid misdiagnosis and mistreatment.
经皮肾镜取石术（PCNL）后出血是一种危险的并发症。假性动脉瘤、动静脉瘘和动脉撕裂是PCNL术后出血的三种最常见原因。肋下动脉出血是一种罕见原因。我们在此报告一例临床病例，患者为一名43岁男性，患有右肾复杂性结石，采用俯卧位经下盏穿刺入路行PCNL治疗。术后1天出现间歇性大量出血，立即进行了肾血管造影。然而，我们未发现假性动脉瘤、动静脉瘘或动脉撕裂的迹象。另一位训练有素且经验丰富的医生也未发现假性动脉瘤、动静脉瘘或动脉撕裂。调整导管位置后，最终发现肋下动脉出血，并成功用弹簧圈控制住出血。这一发现表明肋下动脉损伤是PCNL术后出血的一个原因。我们建议临床医生应仔细、耐心地进行血管造影和/或栓塞，以避免误诊和误治。
