體外震波碎石後急性腎實質出血與後腹腔血腫:案例報告與文獻回顧

蘇奕瑋¹、陳生文²、張彰琦²、邱逸淳²

¹臺北市立聯合醫院仁愛院區外科部泌尿科; ²臺北市立聯合醫院忠孝院區外科部泌尿科

Active Bleeding in Renal Parenchyma and Retroperitoneal Hematoma Associated with Extracorporeal Shock Wave Lithotripsy: A case report and literature review

Yi-Wei Su¹, Sheng-Wen Chen², Chang-Chi Chang², Yi-Chun Chiu²

¹Division of Urology, Department of Surgery, Taipei City Hospital Renai branch

²Division of Urology, Department of Surgery, Taipei City Hospital Zhongxiao branch

Introduction:

Extracorporeal shock wave lithotripsy (ESWL) is a safe and noninvasive procedure for managing renal or ureteral stones. It boasts a high success rate, particularly in cases with smaller stone burdens, and rare complications. Complications of ESWL include hematuria, steinstrasse, renal hemorrhage, and urinoma. The incidence of renal hemorrhage is reported to be less than 1% in previous research. Here, we present the case of a 48-year-old man who underwent ESWL and experienced the rare complication of severe retroperitoneal hemorrhage.

Case presentation: 

A 48-year-old man with no significant past medical history presented to our emergency room (ER) with severe left flank pain at night. Additionally, gross hematuria was noted. Vital signs at triage were stable (saturation: 100%, body temperature: 36℃, pulse rate: 72/min, respiratory rate: 18/min, and blood pressure: 128/86 mmHg). He mentioned that he had undergone ESWL at another hospital earlier at noon.

Physical examination revealed a palpable swelling mass and bruising in the left flank area. Blood examination showed leukocytosis (white blood count: 14840/uL) with no evidence of anemia (hemoglobin: 13.3 g/dL) and an elevated creatinine level (1.3 mg/dL). Computed tomography (CT) revealed an 8 mm stone in the left upper kidney, along with a large amount of acute hematoma in the left perirenal space, left pararenal space, and left retroperitoneum. Active bleeding from the lower pole of the left kidney was also observed. (Figure 1.) The renal trauma was classified as Grade 4 according to the American Association for the Surgery of Trauma (AAST) Kidney Injury Scale.

A consultation with an urologist specializing in genital urology (GU) was sought, and external compression was applied. However, as the patient's hemodynamics became unstable, transarterial embolization (TAE) was suggested and discussed with the patient and his family. Consequently, they decided to transfer him to a medical center.

Conclusion:

        Hematoma related to ESWL is a rare condition that can lead to functional and symptomatic problems, and in some cases, it can be life-threatening. TAE can be applied initially; however, surgical treatment should be considered in these cases. Further follow-up of outcomes after the procedure is crucial.