Published online Nov 26, 2020. doi: 10.12998/wjcc.v8.i22.5790
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
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.
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.
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.