Gallbladder injury by percutaneus nephrostomy access: a nosy rare case.
Gallbladder injury during collecting system access for percutaneous nephrostomy is a rare but potentially life-threatening complication. We report the case of a gallbladder puncture during a percutaneous nephrostomy tube positioning.
A 39 years old woman with severe hydronephrosis was admitted to our hospital. The patient underwent percutaneous nephrostomy tube positioning. This procedure resulted in easy introduction of the guide wire but unsuccessful placement of nephrostomy drainage. In post-operative day 3 the patient developed a clinical picture of uroperitoneum so, under urgency, she was subjected to ureteral reimplantation (with double J stent) for chronic inflammatory stenosis. In the next post-surgery the patient developed an acute abdomen. This framework could be partly attributed to the trauma on the gallbladder following percutaneous access and in part goes far by uro-peritoneum that has contributed to the development of a cholecystitis ball.
Diagnostic laparoscopy revealed significant intra-abdominal adhesions and bilious ascites throughout the intra-abdominal cavity. A laparoscopic cholecystectomy and intraoperative cholangiography with peritoneal irrigation was performed. The patient recovered without any further complication, and was discharged on postoperative day 20. She underwent removal of double J stent on post-operative day 30.
Gallbladder injury during collecting system access for percutaneous nephrostomy is a rare but potentially life-threatening complication. It should be considered in patients with persistent or worsening right upper quadrant pain after right percutaneous nephrolithotomy, and early recognized because cholecystectomy may be necessary.