Transperitoneal laparoscopic pyelolithotomy was done for a young patient with a big (4*3.5cm) renal pelvic stone. The stone was escaped into the peritoneal cavity and was not found. Post-op X-ray shows a big radiopaque structure (retained stone) near the pelvis.
The incidence of this post-procedural complication is so rare that only one case is reported so far in Yemen.
Since the complication is rare, the management options recommended are just expert opinions.
The diagnosis of escaped stone is made intraoperatively and the best management option is to close the pyelolithotomy incision and proceed with intraperitoneal exploration to find the lost stone. In difficult circumstances, this may be impossible and can even be a reason for iatrogenic injury to intraperitoneal structures. In such difficulties, i think it is better to stop the procedure and return the patient to the ward. The incident can be discussed with the patient and further management options can be decided. Here, i think an open or laparoscopic peritoneal exploration is possible after localizing the stone with a imaging.
A surgeon should avoid open peritoneal exploration to remove the stone on the same surgery day since this might result in a legal allegation. Most patients choose laparoscopy for its cosmetic advantage and short hospital stay. Patient consent is mandatory if open exploration is decided and this is better be done few days or weeks after the first surgery.
I don't think an escaped stone can be managed conservatively. The evidences are scarce to comment on the place of conservative management. However, the decision to do so appears to be dependent on the patient's preference.
Usually stone surgeries is done with extraperitoneal approachs and we know the escaped stones to extraperitoneal can be left if no comperession on other structures. For stone escaped to intraperitoneal space there is recommendation and as Khaleb said depend on expert opinion as it is very rare but it may be managed with the same concept.
Usually stone surgeries is done with extraperitoneal approachs and we know the escaped stones to extraperitoneal can be left if no comperession on other structures. For stone escaped to intraperitoneal space there is recommendation and as Khaleb said depend on expert opinion as it is very rare but it may be managed with the same concept.
In analogy with bilary stones escaped when perforating a gallbladder dring cholecystectomy. If these stone(s) are missed or volontary let, it can provoque peritoneal abcess or entercutaneos fistulae. Than if possibles, this stone must be removed.