Abstract:
Percutaneous nephrolithotomy is a minimally invasive intervention for renal stone
disease. Complications, which are rare and usually presented as case reports, are diversified as the
utilization of the procedure is expanded. The procedure causes less blood loss and less morbidity
when compared to open surgical procedures. Yet, there are some reports involving severe
bleeding and relevant morbidity during surgery. These are usually related with the surgical
technique or experience of the surgeon.
Renal sheaths are designed to cause minimal trauma inside the kidney and, to our knowledge, there
are no reports presenting the rupture of a sheath causing severe bleeding during the procedure.
Case report: We present an adult patient who had severe bleeding during percutaneous
nephrolithotomy due to parenchymal injury caused by a ruptured renal sheath. During retrieval,
due probably to rough handling of the equipment, a piece of stone with serrated edges ruptured
the tip of the sheath, and this tip caused damage inside the kidney. The operation was terminated
and measures were taken to control bleeding. The patient was transfused with a total of 1600 ml
of blood, and the stones were cleared in a second look operation.
Conclusion: Although considered to be a minimally invasive procedure, some unexpected
complications may arise during percutaneous nephrolithotomy. After being fragmanted, stone
pieces may damage surgical equipment, causing acute and severe harm to the kidney. Surgeons must
manipulate the equipment with fine and careful movements in order to prevent this situation.
