Gall Bladder Perforation During Percutaneous Nephrolithotripsy: Lessons Learned.

Percutaneous nephrolithotripsy (PCNL) is the recommended procedure for patients with large and complex renal calculi. Visceral injuries are rare complications of this procedure. A distended gall bladder (GB) that abuts the right kidney is more prone to needle puncture-related injuries. A GB injury leading to peritonitis portends a poorer prognosis. We report a case of GB perforation that happened after an otherwise uneventful PCNL, which was managed with a prompt intraoperative decision of performing laparoscopic cholecystectomy. The initial puncture yielded a straw-colored, gelatinous aspirate, alerting the treating surgeon. After the completion of the PCNL, a diagnostic laparoscopy was performed. The GB was found to be injured and a bile leak was observed. Elective cholecystectomy was performed. Awareness of this potentially lethal complication and a high index of clinical suspicion is mandatory, as early diagnosis and prompt management can prevent mortality in such patients.