Endoscopic Closure of Colon Perforation After Percutaneous Nephrolithotomy

Abstract

Colon perforation is a rare complication of percutaneous nephrolithotomy (PCNL). It is classically treated conservatively, with broad-spectrum parenteral antibiotics, fasting, and the use of two separate drains (one for the urinary system and one for the bowel). In this setting, we report the use of the endoscopic full-thickness suturing device over-the-scope clip (OTSC). An experienced gastroenterologist applied the OTSC after identifying the colon perforations during colonoscopy. Patients presented with fever, subcutaneous emphysema, and percutaneous enteric drainage. One patient presented at the 1st post-operative day, after percutaneous nephrostomy tube (PCNT) removal, and conservative management was attempted for 5 days, without improvement. The second patient presented at the 4th day, with PCNT still in place, trespassing the colon, and two OTSC were immediately placed, during PCNT removal under direct visualization. Afterwards, the diet was started in 2 days, and patients were discharged in 4 days. Thus, endoscopic management of colon perforation with the full-thickness suture device OTSC seems a minimally invasive alternative to the classic conservative treatment, or an option for when it fails, in stable patients with retroperitoneal perforations.