title: Severe renal bleeding caused by a ruptured renal sheath: case report of a rare complication of percutaneous nephrolithotomy.
abstract: BACKGROUND
  Percutaneous nephrolithotomy is a minimally invasive intervention for renal stone disease. Complications, which are rare and usually presented as case reports, are diversified as the utilization of the procedure is expanded. The procedure causes less blood loss and less morbidity when compared to open surgical procedures. Yet, there are some reports involving severe bleeding and relevant morbidity during surgery. These are usually related with the surgical technique or experience of the surgeon. Renal sheaths are designed to cause minimal trauma inside the kidney and, to our knowledge, there are no reports presenting the rupture of a sheath causing severe bleeding during the procedure.
  
  
  METHODS
  We present an adult patient who had severe bleeding during percutaneous nephrolithotomy due to parenchymal injury caused by a ruptured renal sheath. During retrieval, due probably to rough handling of the equipment, a piece of stone with serrated edges ruptured the tip of the sheath, and this tip caused damage inside the kidney. The operation was terminated and measures were taken to control bleeding. The patient was transfused with a total of 1600 ml of blood, and the stones were cleared in a second look operation.
  
  
  CONCLUSIONS
  Although considered to be a minimally invasive procedure, some unexpected complications may arise during percutaneous nephrolithotomy. After being fragmanted, stone pieces may damage surgical equipment, causing acute and severe harm to the kidney. Surgeons must manipulate the equipment with fine and careful movements in order to prevent this situation.
authors.affiliation: Department of Urology, Inönü University, Faculty of Medicine, Malatya, Turkey. mugras35@yahoo.com
authors.forename: Murat
authors.initials: M
authors.lastname: Ugras
authors.forename: Ali
authors.initials: A
authors.lastname: Gunes
authors.forename: Can
authors.initials: C
authors.lastname: Baydinc
mesh_terms: D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007668:Kidney / Q000293:injuries; D007669:Kidney Calculi / Q000150:complications* / Q000601:surgery*; D007674:Kidney Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects*; D012421:Rupture; D015607:Stents; D014950:Wounds, Penetrating / Q000209:etiology