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COMMENTS |
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| Year : 2006 | Volume
: 22
| Issue : 1 | Page : 78 |
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Comments on Fulminant biliary peritonitis.........................
Peter Ramsden
Consultant. Urologist, Freeman Hospital, Newcastle upon Tyne, United Kingdom
Correspondence Address:
Peter Ramsden
Consultant. Urologist, Freeman Hospital, Newcastle upon Tyne
United Kingdom
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Ramsden P. Comments on Fulminant biliary peritonitis......................... Indian J Urol 2006;22:78 |
Puncture of the Biliary tract at percutaneous nephrostomy is clearly a potentially serious complication, although not frequently documented. The authors of this case report have courageously reported a fatal outcome. My comments are.
1. It is not correct to say this was an uneventful PCNL.
2. Bile gushing from the needle puncture could be due to high pressure in the gall bladder. Was there in background gall bladder disease.?
3. The decision to remove the nephrostomy in the early post-operative period in the presence of an obvious fever is open to question.
4. The final conclusion of the authors to carry out immediate cholecystectomy and then completing PCNL is certainly contentious and should be discussed. Alternative management plans could be :
a. Simply leave a pigtail catheter to the gall bladder and discontinue the procedure.
b. After consultation proceed to immediate laparoscopic cholecystectomy, with deferment of the PCNL.
5. This complication could occur at PCNL and not be detected at the time and the case highlights the need to be aware of this potential complication in any patient that does not progress smoothly post operation.
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