Liu Q, Yang C, Lin K, Yang D. Bleeding of two lumbar arteries caused by one puncture following percutaneous nephrolithotomy: A case report. World J Clin Cases 2020; 8(22): 5790-5794 [PMID: 33344575 DOI: 10.12998/wjcc.v8.i22.5790]
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Kai Lin, Interventional Radiology, Hanchuan People’s Hospital, Hanchuan 432300, Hubei Province, China
Author contributions: Liu Q and Yang D were the patient’s bedside clinicians, analyzed and interpreted the imaging findings, reviewed the literature and contributed to manuscript drafting; Yang C performed the angiographic image acquisition and interpretation and contributed to manuscript drafting; Liu Q and Lin K performed the renal angiography and embolization; All authors issued final approval for the version to be submitted.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Received: August 21, 2020 Peer-review started: August 21, 2020 First decision: September 13, 2020 Revised: September 21, 2020 Accepted: October 1, 2020 Article in press: October 1, 2020 Published online: November 26, 2020 Processing time: 96 Days and 12.5 Hours
Abstract
BACKGROUND
Lumbar artery bleeding is an uncommon complication of percutaneous nephrolithotomy (PCNL). This report presents a rare complication where two lumbar arteries were injured by a single puncture following PCNL. Only scarce reports of this complication have been reported.
CASE SUMMARY
A 24-year-old man presented with a 2.2 cm right renal calculus, which was managed by PCNL. During nephrostomy tube removal on the 6th postoperative day, intense bleeding was observed in the fistula and the catheter. Renal angiography was undertaken immediately; however, an initial selective renal angiogram revealed no evidence of renal vascular injury. One of these injuries involved a pseudoaneurysm from a peripheral branch in the first right lumbar artery, while the other involved an arteriovenous fistula from a peripheral branch in the second right lumbar artery. Subsequently, coil embolization was performed successfully.
CONCLUSION
This case is being reported to inform clinicians that lumbar artery damage is one of the causes of severe bleeding after PCNL and could involve damage of more than one artery.
Core Tip: Lumbar artery bleeding is an uncommon complication of percutaneous nephrolithotomy (PCNL). This report presents a case where the bleeding of two lumbar arteries was caused by one puncture following PCNL. Radiological imaging revealed pseudoaneurysm and arteriovenous fistula as the two injuries. This case is being reported to inform clinicians and interventional radiologists that lumbar artery damage is one of the causes of severe bleeding after PCNL, and could involve damage of more than one artery. Angiography and embolization should be performed patiently and carefully to avoid underdiagnosis or missed diagnosis.
