Analysis of Hemorrhagic Shock Following Percutaneous Nephrolithotomy Resulting from Diaphragm Injury: A Case Report.

Background: Percutaneous nephrolithotomy (PCNL) is the first treatment for complex renal and/or ureteral calculi. This paper presents a case of hemorrhagic shock resulting from diaphragm injury due to PCNL, which has not been reported so far.

Case presentation: A 55-year-old Asian woman presented with a 2 × 2 cm calculus located in the upper calyx of the right kidney. After her uncomplicated PCNL operation, the patient's blood pressure decreased to less than 90/60 mmHg, and her hemoglobin level dropped from 128 g/L to 76 g/L. Physical examination and bedside ultrasound indicated a small amount of pleural effusion. Subsequently, a diagnostic puncture of the chest cavity was performed and revealed the presence of fresh blood. Therefore, thoracic closed drainage was conducted, and 950 mL of fresh blood was drained through a drainage tube. Intraoperatively, observation showed that the nephrostomy tube had penetrated the kidney through the diaphragm. The nephrostomy tube was subsequently removed, and the diaphragm was repaired.

Conclusions: Hemorrhagic shock due to diaphragm injury is an unusual complication after PCNL. This complication should be considered if pleural effusion is present and if blood pressure progressively drops with no other obvious explanation. The recommended treatments include diagnostic thoracentesis and thoracic exploration.