Splenic Injury During Percutaneous Nephrolithotomy

BACKGROUND: Injury to the spleen is a recognized complication during percutaneous renal access due to the close anatomical relationship of the spleen and the left kidney. However, transsplenic renal access is a rare complication of percutaneous nephrolithotomy and can also result in considerable morbidity, often requiring emergent splenectomy. METHODS: We present our experience with splenic injury during percutaneous nephrolithotomy managed conservatively with the use of a collagen-thrombin hemostatic sealant (D-Stat; Vascular Solutions, Inc., Minneapolis, MN) after delayed removal of the nephrostomy tubes. RESULTS: The patient had an uneventful recovery and was discharged home on postoperative day 6. CONCLUSION: In select hemodynamically stable patients, nonoperative management with the adjunctive use of hemostatic sealants may be considered.