Community Medical Center, Toms River, New Jersey.
J Emerg Med. 2020 Jul;59(1):e21-e23. doi: 10.1016/j.jemermed.2020.03.016. Epub 2020 Apr 27.
Shockwave lithotripsy (SWL) is a common procedure, which can result in rare, life-threatening complications, such as splenic rupture, perinephric hematoma, sepsis, and ureteral colic from retained stone. Being able to identify these complications can result in successful diagnosis and expedited management.
We describe the case of an 82-year-old female presenting to the emergency department (ED) for hypotension and vomiting. The patient had undergone SWL for a kidney stone earlier in the day. On initial evaluation, the patient was hypotensive and reported mild abdominal pain. Although initially evaluated and treated for presumed sepsis, thorough testing was able to diagnose splenic rupture and hemoperitoneum. Splenic rupture is a rare complication of SWL and the patient's initial symptoms of hypotension and fever, with a potential source of infection, suggested a common presentation of sepsis and made this case a unique diagnostic challenge. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Diagnosis is always a challenge in the ED, due to the variability of patients that can be seen. Often times, a patient's medical and surgical history will provide guidance. For this reason, it is important to know what complications exist with outpatient procedures, how they may present, and what patient risk factors may lead to an increased incidence.
体外冲击波碎石术（SWL）是一种常见的程序，可能导致罕见的、危及生命的并发症，如脾破裂、肾周血肿、败血症和输尿管绞痛，这些并发症源于残留的结石。能够识别这些并发症可以导致成功的诊断和加快管理。
我们描述了一名 82 岁女性因低血压和呕吐到急诊科就诊的病例。该患者当天早些时候接受了肾结石 SWL 治疗。在初步评估时，患者血压低，报告有轻度腹痛。尽管最初评估并治疗了疑似败血症，但彻底的检查能够诊断出脾破裂和腹腔积血。脾破裂是 SWL 的罕见并发症，患者最初的低血压和发热症状，以及感染的潜在来源，提示了败血症的常见表现，使该病例成为一个独特的诊断挑战。
为什么急诊医生应该注意这一点？：由于可以看到的患者的多样性，诊断在急诊科总是具有挑战性。通常情况下，患者的医疗和手术史将提供指导。因此，了解门诊程序存在哪些并发症、它们可能如何表现以及哪些患者的风险因素可能导致发病率增加是很重要的。
