Following a percutaneous nephrolithotomy surgery that was meant to remove a kidney stone with minimal invasion, a woman suffered severe medical complications that caused her to pass away shortly after the procedure. With multiple stones in her left kidney, the woman’s doctors decided to remove the stones by making a small incision and inserting a device to push the kidney stones through her urinal tract. While recovering from the anaesthesia, the patient became hypotensive and was taken back to the emergency room where she had four liters of blood removed. Doctors discovered that her spleen had been punctured all the way through during surgery, and a general surgeon was brought in to assist with the splenectomy. Postoperatively, the patient developed abdominal compartment syndrome and passed away within 48 hours. A urologist was needed to look over her case for trial and provide a professional perspective on the consequences and developments after the attempted kidney stone removal.
Question(s) For Expert Witness
1. Do you perform percutaneous nephrolithotomy procedures in your practice?
2. How common is puncturing of the spleen in percutaneous nephrolithotomy?
Expert Witness Response E-085517
I routinely perform percutaneous nephrolithotomy, and splenic injury is an extremely rare complication with only a few reports in the literature. I routinely lecture on safe access for percutaneous nephrolithotomy, most recently in Cape Town South Africa at the World Congress of Endourology.
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