Case ReportsSplenic rupture and abscess after extracorporeal shock wave lithotripsy
Section snippets
Case report
A 37-year-old man presented with urinary tract infection and left flank pain. An intravenous urogram showed a partially obstructive stone at the inferior pole of the left kidney associated with mild hydronephrosis. After successful treatment of the infection, he underwent ESWL (Dornier MFL 5000 lithotriptor). He received a total of 2400 impulses at 24 kV in a single section.
After ESWL, left flank pain was noted and 3 days later, fever (38.5°C) and vomiting developed. He presented to the
Comment
Complications of ESWL are rare, and we found only two published reports of splenic rupture after ESWL.4, 5 Different from our patient, these 2 cases occurred in patients with previous splenic abnormalities, which may have contributed to the rupture.
There are no studies on the effects of ESWL in the spleen, probably because of its rarity and the difficult functional evaluation of this organ. We believe that the alterations observed in some kidneys (intraparenchymal and perirenal hemorrhage, as
References (5)
- et al.
First clinical experience with extracorporeally induced destruction of kidney stones by shock waves
J Urol
(1982) - et al.
Report of the United States cooperative study of extracorporeal shock wave lithotripsy
J Urol
(1986)
Cited by (26)
A Case of Splenic Injury After Shockwave Lithotripsy Presenting as Septic Shock
2020, Journal of Emergency MedicineCitation Excerpt :Due to the limited nature of the evidence surrounding this adverse reaction of a commonly used procedure, it is difficult to identify a true causative reason to determine which patients are at highest risk for splenic laceration. While there have been extensive studies evaluating renal injury occurring as a result of SWL, there have been only 12 previously published case reports of splenic laceration (2–13). Common themes among the case reports included utilization of high energy levels, notably more than 2000 shocks, and treatment of the laceration with a splenectomy.
Medical and Interventional Management of Upper Urinary Tract Uroliths
2019, Veterinary Clinics of North America - Small Animal PracticeCitation Excerpt :Extracorporeal shockwave lithotripsy is contraindicated in patients that are coagulopathic. In addition, damage of surrounding tissues can occur, and in humans reported complications include: perforation of the colon, rupture of the hepatic artery, hepatic hematoma, pneumothorax, urinothorax, rupture of the spleen, acute necrotizing pancreatitis, dissecting abdominal wall abscess, rupture of the abdominal aorta, and iliac vein thrombosis.46–58 These complications are very rare.
A Novel Case of Splenic Injury After Shockwave Lithotripsy
2017, Journal of Emergency MedicineCitation Excerpt :Less common complications include extrarenal tissue injury; intra-abdominal bleeding/abscess formation, abdominal aorta rupture, pneumothoracies, liver and pancreatic hematomas, pancreatitis, perforation of bowel, and splenic rupture/hematoma/abscess (6). To our knowledge there have only been eight published cases of splenic injury associated with SWL (7–14). Splenomegaly, bleeding disorders, and movement during the procedure can increase the risk of splenic injury (6).
The impact of shock wave lithotripsy on male fertility: A critical analysis of existing evidence
2012, UrologyCitation Excerpt :Most of these studies focused on the impact of shock waves on renal tissue.1 SWL may also have some impact on surrounding organs, and post-SWL complications related to the bowel, spleen, liver, pancreas, lung and major vascular structures have been reported.1,3-7 The pathophysiological pathways involved in shock wave–induced tissue damage have not been well elucidated.
Complications of extracorporeal shock wave lithotripsy
2009, Complications of Urologic Surgery: Expert ConsultThe Acute and Long-Term Adverse Effects of Shock Wave Lithotripsy
2008, Seminars in NephrologyCitation Excerpt :However, reports of damage outside the kidney are noteworthy and may be additional cause for concern. A sampling of such findings (Table 4) includes perforation of the colon, rupture of the hepatic artery, hepatic hematoma, pneumothorax, urinothorax, rupture of the spleen, acute necrotizing pancreatitis, dissecting abdominal wall abscess, rupture of the abdominal aorta, and iliac vein thrombosis, among others.26-38 Virtually all patients who undergo SWL for renal stones show hematuria after receiving about 200 SWs.1