Conservative Management of a Splenic Injury Related to Percutaneous Nephrostolithotomy

INTRODUCTION Injury to intraperitoneal organs is unusual during percutaneous renal surgery. We report a splenic injury during upper pole percutaneous renal access for nephrostolithotomy that was managed conservatively. METHODS A 52-year-old male with left upper pole renal stones associated with a narrow upper pole infundibulum underwent upper pole renal access prior to percutaneous nephrostolithotomy (PCNL). The access was performed in the 10th to 11th intercostal space, and the patient underwent PCNL with stone clearance. Plain film radiography after percutaneous access and PCNL revealed no pneumothorax or hydrothorax. The patient was discharged on postoperative day one with the nephrostomy tube in place. RESULTS On postoperative day 5, the patient was evaluated for persistent flank pain and bleeding from the nephrostomy tube. Computerized tomography revealed a transsplenic percutaneous renal access. The patient was admitted to the hospital, and the general surgery service was consulted. The patient was placed on strict bedrest. His hematocrit was within normal limits and remained stable. The nephrostomy tube was kept in place for 2 weeks. A pullback nephrostogram revealed no perirenal leak, and no evidence was present of acute bleeding. Follow-up computerized tomography on the same day revealed no evidence of acute bleeding. The patient was discharged without further complications and remains stone free at 1-year follow-up. CONCLUSIONS A transsplenic renal access that was dilated and through which a successful left percutaneous nephrostolithotomy was performed is a highly unusual complication related to upper pole left renal access. We were able to manage this complication with conservative measures.