Clinical Pathology Case

199Urology Journal    Vol 7    No 3    Summer 2010

A Complication After Percutaneous Nephrolithotomy
Farzaneh Sharifiaghdas, Nasser Simforoosh, Ardalan Ozhand

Urol J. 2010;7:199-200.
www.uj.unrc.ir

Urology and Nephrology Research 
Center, Shahid Labbafinejad 

Medical Center, Shahid Beheshti 
University, M.C., Tehran, Iran

CASE PRESENTATION
A 24-year-old woman with 
left renal pelvis and lower 
calyceal stones was admitted for 
percutaneous nephrolithotomy 
(PCNL) (Figure 1).

The surgery was uneventful. 
Nephrostomy tube and ureteral 
stent were removed on the 2nd 
postoperative day. Soon after, 
urine leakage from the site of 
the nephrostomy tube and fever 
developed. Temperature was as 
high as 39˚C and leukocytosis up 
to 20 000/mm3, with neutrophils as 
the dominant part (80%),  

was reported.

Double J stent was inserted 
through ureteroscope. On the 
3rd postoperative day, the patient 
showed signs and symptoms of 
obstipation, vomiting, abdominal 
tenderness and rebound tenderness, 
and high fever. Plain abdominal 
x-ray at supine and upright position 
revealed air fluid level and no 
evidence of gas pattern in the pelvis 
(rectum) and sentinel loop in the 
left upper quadrant (Figure 2). 
Chest x-ray revealed pleural 
effusion in both sides (Figure 3).

Figure 1. Intravenous urography demonstrates a 3-cm stone in the left kidney.

A B



Clinical Pathology Case

200 Urology Journal    Vol 7    No 3    Summer 2010

QUIZ
What could be the possible cause of the 
abdominal pain and obstipation?

What is your suggestion as the next step of 
diagnosis and treatment?

The answers will be discussed in the next issue of 
Urology Journal.

Figure 2. Plain Abdominal radiography shows multiple air fluid 
level patterns and empty pelvic cavity.

Figure 3. Chest x-ray reveals bilateral pleural effusion.