Marinkovic SP et al, 2015: Spleen injury following left extracorporeal shockwave lithotripsy (ESWL).
Marinkovic SP, Marinkovic CM, Xie D.
Department of Urology, Detroit Medical Center-Harper and Hutzel Hospitals, Detroit, Michigan, 48201, USA.
BACKGROUND: A splenic rupture associated with extracorporeal shockwave lithotripsy (ESWL) is exceedingly rare. We report a case of stage 3 splenic laceration, hemoperitoneum and subsequent splenic rupture following an ESWL for a left mid polar renal calculus.
CASE PRESENTATION: During the ESWL, although the patient's pain was controlled the gentleman was very nervous and had to be repositioned eight individual times. Approximately 6 hours after the ESWL, the patient phoned the urologist complaining of severe left flank pain unlike any previous episode of renal colic. A computerized tomography (CT) scan demonstrated a stage 3 splenic injury with hemoperitoneum. The patient decompensated and an emergent splenectomy was then performed and the patient experienced an uneventful recovery.
CONCLUSIONS: Splenic injury likely results from unintentional movement during the sound wave administration for the stone fragmentation procedure. Utilizing noise cancelling headphones during ESWL may preclude the potential pitfalls of patient nervousness.
BMC Urol. 2015 Feb 18;15:4. doi: 10.1186/1471-2490-15-4. FREE ARTICLE
Splenic rupture is an extraordinary rare complication of SWL. I have personally not seen this complication despite being responsible for more than 25 000 treatments. The authors explain this outcome as a consequence of frequent re-positioning of the patient during treatment. Their solution to the problem – difficult to know how common it is – was to use head phones to reduce SWL noise. Alternatively, it would make sense to use a belt and, moreover, to make sure that the patient is treated with sufficient pain relief with or without sedation in order to allow for appropriate targeting.