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Ehemann J. et al., 2023: Rare vascular complication of ESWL pseudoaneurysm of arc of Buhler

Ehemann J, Kim JJY.
Urology, Gold Coast University Hospital, Southport, Queensland, Australia
Urology, Gold Coast University Hospital, Southport, Queensland, Australia

Abstract

Extracorporeal shock wave lithotripsy (ESWL) is a standard treatment for nephrolithiasis. It is widely employed due to its relative safety profile when compared with other treatment options. Recognised complications include localised pain at site, steinstrasse, perinephric haematoma and ureteric obstruction. This report presents a rare non-documented complication of ESWL, pseudoaneurysm of the arc of Buhler, a branch artery of the superior mesenteric artery.

BMJ Case Rep. 2023 Jul 25;16(7):e256089. doi: 10.1136/bcr-2023-256089. PMID: 37491127

 

 

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Comments 1

Hans-Göran Tiselius on Friday, 02 February 2024 10:00

This case report of a ruptured pseudoaneurysm after SWL is interesting, particularly because it caused a radiological image similar to any other perinephric hematoma. The origin of the bleeding was a jejunal branch of the superior mesenteric artery.

The patient was unfortunate in two aspects, firstly because of the extensive bleeding and secondly because of the obstructing ureteral stone. The latter is described as steinstrasse, but it looks more like a residual solid stone/stone fragment.

Nothing is mentioned on whether the patient had hypertension or not, but the immediate clinical impression would be a renal hematoma and the question can be raised if the bleeding had stopped without embolization?

Hans-Göran Tiselius

This case report of a ruptured pseudoaneurysm after SWL is interesting, particularly because it caused a radiological image similar to any other perinephric hematoma. The origin of the bleeding was a jejunal branch of the superior mesenteric artery. The patient was unfortunate in two aspects, firstly because of the extensive bleeding and secondly because of the obstructing ureteral stone. The latter is described as steinstrasse, but it looks more like a residual solid stone/stone fragment. Nothing is mentioned on whether the patient had hypertension or not, but the immediate clinical impression would be a renal hematoma and the question can be raised if the bleeding had stopped without embolization? Hans-Göran Tiselius
Monday, 20 May 2024