SWL literature
SWL Literature

Gitonga EN et al., 2021: Small bowel obstruction and strangulation secondary to an adhesive internal hernia post ESWL for right ureteral calculi: a case report and review of literature.

Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China.
Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China.

Abstract

Background: Extracorporeal shock wave lithotripsy (ESWL) is a relatively safe and convenient mode of treatment for ureteral and renal stones, despite its relative safety; ESWL is not without its complications. We present a case of a patient we managed for small bowel obstruction and strangulation due to an adhesive internal hernia after ESWL was done because of right ureteral calculi.

Case presentation: We report a case of a 59-year-old patient who presented with severe abdominal pain a few hours after ESWL because of a right upper ureteric calculus. The abdominal pain increased in severity in time and became more generalized. The patient had one episode of gross hematochezia as she was being prepped for emergency laparotomy. Intra-op, she had a strangulated internal hernia because of an omental-mesenteric adhesion.

Conclusion: This case report hopes to highlight the potential of complications like acquired IH due to adhesions in patients with a history of ureteral calculi, and also the complications that may come about post-ESWL. Patients who present with signs of persistent abdominal pain post-ESWL should be vigilantly observed. If symptoms persist, increase in intensity or there is a general deterioration of the patients' hemodynamic status, even in light of negative MDCT findings, prompt surgical intervention is crucial for definitive diagnosis as well as management.
BMC Gastroenterol. 2021 Apr 17;21(1):176. doi: 10.1186/s12876-021-01760-2. PMID: 33865311. FREE ARTICLE

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Comments 1

Hans-Göran Tiselius on Tuesday, October 26 2021 08:30

The authors describe an extremely unusual complication after SWL of a right-sided ureteral stone. The details of the SWL treatment are not reported and it is not mentioned if the patients had shockwaves directed from the back or transabdominally.

The golden rule is to carefully search for an explanation in all patients with persistent pain after SWL. The most common complication is perirenal/subcapsular hematoma, but if CT excludes that diagnosis, it is necessary to search for intestinal injuries and damage of other intraabdominal organs, some of which can be difficult to identify with CT. This patient exemplifies that a correct diagnosis only could be established following direct inspection of he abdominal cavity.

Hans-Göran Tiselius

The authors describe an extremely unusual complication after SWL of a right-sided ureteral stone. The details of the SWL treatment are not reported and it is not mentioned if the patients had shockwaves directed from the back or transabdominally. The golden rule is to carefully search for an explanation in all patients with persistent pain after SWL. The most common complication is perirenal/subcapsular hematoma, but if CT excludes that diagnosis, it is necessary to search for intestinal injuries and damage of other intraabdominal organs, some of which can be difficult to identify with CT. This patient exemplifies that a correct diagnosis only could be established following direct inspection of he abdominal cavity. Hans-Göran Tiselius
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Sunday, November 28 2021

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