Presentation Authors: Eric Raffin*, Lebanon, NH, Ben Chew, Vancouver, Canada, Bodo Knudsen, Coumbus, OH, Nicole Miller, Nashville, TN, Vernon Pais, Lebanon, NH
Introduction: Splenic injury is a rare complication after left sided percutaneous nephrolithotomy (PCNL). A total of only 11 occurrences have been reported in the literature. Although initial observation is often espoused, the outcomes of non-operative, conservative management are not well established and the implications of splenic injury are not fully defined in this context. We sought to describe outcomes of conservative management of splenic injury incurred at PCNL.
Methods: We performed a multi-institutional retrospective review of individual patients who underwent PCNL complicated by trans-splenic nephrostomy access injury. Demographic info, intraoperative data, management strategies, and outcomes were reviewed.
Results: There were a total of 6 patients with splenic injury after left PCNL. 67% were male. Average age was 49.8 years. Average BMI was 28.9 kg/m2. The average stone size was 42.6mm (range 12-91). All patients had at least one supracostal, upper pole access done under fluoroscopic guidance. Splenic injury was identified by CT in the 5 of 6 (83%) who had imaging on first postoperative day. All were managed conservatively with nephrostomy dwell time of 2-21 days, none of whom had further sequelae or delayed bleed. The remaining 1 patient (17%) â€“ who had neither nephrostomy tube in place nor imaging post-op â€“ presented 5 days postoperatively with a delayed bleed and underwent emergent splenectomy.
Conclusions: The majority of patients incurring splenic injury during PCNL can be successfully managed conservatively with maintenance of nephrostomy tube for 2 days or greater. Although rare, this complication underscores the role of routine postoperative CT to allow timely diagnosis, particularly in those undergoing upper pole, supracostal left sided percutaneous renal access. Clinicians must remain vigilant for potential delayed bleeding during the first postoperative week and counsel patients accordingly.