Staghorn calculi pose challenges in urology, often necessitating more invasive procedures such as percutaneous nephrolithotomy (PCNL) to clear a large stone burden with fewer procedures. Here we present a case of a 76-year-old female with chronic kidney disease and a malrotated right pelvic kidney who underwent PCNL for a 3.5 cm staghorn calculus. Postoperatively, she developed a rare complication of ascending colon perforation, requiring emergent surgical intervention including exploratory laparotomy and right hemicolectomy. Colon perforation during PCNL is rare (0.3%-0.8%). Preoperative imaging, namely computed tomography (CT) of the abdomen and pelvis, is crucial to identify anatomical variations and mitigate the risk of injury. Conservative management strategies have demonstrated success in similar cases, emphasizing the importance of prompt recognition and multidisciplinary management. This case contributes to the paucity of literature regarding this rare complication underscoring the necessity for detailed preoperative planning to avoid complications in PCNL, especially in patients with complex renal anatomy. Future research should focus on developing tailored guidelines for PCNL in patients with anatomical abnormalities to enhance procedural safety and optimize outcomes.
Copyright © 2024 Christina S. Boutros et al.