Trans-splenic puncture during percutaneous nephrolithotomy: Outcome spectrum of the same complication

Percutaneous nephrolithotomy is an endourologic technique commonly used in the management of nephrolithiasis. However, this procedure is not complication-free. Splenic injury is exceptionally rare with a reported rate of 1% from the total case load. We present herein two cases of splenic puncture during percutaneous nephrolithotomy that illustrate two different outcomes. In the first case, the patient remained asymptomatic and was discharged on her third post-operative day after removing the nephrostomy, without any sign of hemodynamic compromise. In the second case, the patient presented with hemodynamic instability and an abdominal computed tomography scan was done that showed free fluid in the peritoneal cavity. Emergency laparotomy was performed and revealed a deep peripheral laceration (20 mm × 5 mm in length) that required splenectomy. After a thorough review of the existing literature, we could find only 11 other instances of injury to the spleen in which treatment outcomes were reported. Patient hemodynamic status was the main factor in deciding on the type of treatment.