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The patient had a pelvocaliceal stone and PCNL was performed in the prone position with the guidance of flouroscopy through a single lower pole access. The operation was an easy-going and simple one.
Preoperative KUB
Preoperative IVU
Patient was well on the day one after PCNL and KUB revealed stone-free state.
On the day two, the patient complained of diffuse abdominal pain and obstipation. Vomiting and nausea also were present along with anuria.In physical examination low grade fever, diffuse abdomonal tenderness and distention were detected. Serum creatinine rising from normal to 2.6 mg/dl occured. KUB revealed diffuse gaseousness with some distended intestinal loops.
Postoperative KUB (day 2)
Nephrostography was performed and there was no urinary extravasation or obstruction. Ultrasonography of abdomen was also normal except a little fluid in the abdomen.
Surgical consult was requested and the patient scheduled for laparotomy with the first impression of colon perforation. During exploration through midline abominal incision the following picture was encountered.
Volvulus of sigmoid was apparent and no colon damage or other pathologies were detected. After de-rotating the volvulus the patient was scheduled for later elective sigmoidectomy. The patient post-exploration period was event-less and discharged home with good condition.
Abdiminal pain after PCNL may have several causes including complication directly related to PCNL like hematoma, urinoma and injury to adjacent structures. However unrelated causaes of acute abdomen must not be overlooked.