Severe acute pancreatitis with abscess after extracorporeal shock wave lithotripsy: a rare complication
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ORIGINAL PAPER
Severe acute pancreatitis with abscess after extracorporeal shock wave lithotripsy: a rare complication Chu-Hao Weng • Pei-Yin Ho • Chia-Chi Tsai • Jong-Ming Hsu • Marcelo Chen • Wun-Rong Lin
Received: 13 May 2012 / Accepted: 8 December 2012 / Published online: 23 December 2012 Ó Springer-Verlag Berlin Heidelberg 2012
Abstract Extracorporeal shock wave lithotripsy (ESWL) is a widely accepted procedure for urolithiasis. However, the shock waves do not pass through the body without damage. Here, we reported a 57-year-old man who underwent ESWL four times before, and immediately developed acute pancreatitis and peritoneal abscess after ESWL for a right renal stone. Although the possibility of post-ESWL acute pancreatitis is extremely low, urologists must be aware of this vital complication. Keywords Acute pancreatitis Extracorporeal shock wave lithotripsy ESWL ESWL complication Peritonitis Renal stone
Introduction Extracorporeal shock wave lithotripsy (ESWL) is a wellestablished and widely accepted procedure for urolithiasis due to its safety, effectiveness, noninvasive nature, and ease of use. However, the shock waves do not pass through the body without damage. In addition to the complications related to stone fragments and infection, tissue effects after
C.-H. Weng J.-M. Hsu M. Chen W.-R. Lin (&) Department of Urology, Mackay Memorial Hospital, 92, Sec.2 Chung-Shan N. Rd, Taipei, Taiwan e-mail: [email protected] P.-Y. Ho Graduate Institute of Oncology, National Taiwan University, Taipei, Taiwan C.-C. Tsai Department of General Surgery, Mackay Memorial Hospital, Taipei, Taiwan
ESWL may cause serious injury to kidneys and adjacent organs. Here, we reported a middle-aged man, who had acute pancreatitis with abscess after ESWL for a right renal stone.
Case report A 57-year-old man presented at outpatient department with recurrent renal stones. He has undergone ESWL four times for left ureteral stones and right renal stones during the past 7 years. He had no abdominal pain, nausea, or vomiting in the past. An abdominal X-ray examination showed renal stones 1.6 9 0.9 cm at the right kidney and 1.1 9 0.9, 1.2 9 0.9 cm in the left. He had no gallstone or hyperlipidemia and did not take any drugs. He is a non-smoker and drinks a few shots of alcohol once a week. He underwent ESWL (Medispec E-3000) because of a right lower pole renal stone in the supine position under intravenous general anesthesia. A total of 3,000 shocks were delivered from an electrohydraulic generator within 45 min. The shocks were increased gradually from 200 shocks at 18, 20, and 22 kv to 2,400 shocks at 24 kv. There were no additional complications during ESWL. About 4 h after ESWL, he vomited several times and had abdominal pain later. He came to our emergency department and was admitted the next evening. During his hospital stay, he received intravenous antibiotics, bowel rest, and analgesics. However, the patient complained of abdominal muscle defense with rebounding pain the first morning after admission,
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