Colonic perforation after extracorporeal shock wave lithotripsy

History and clinical findings: A 40-year-old man had undergone extracorporeal shock wave lithotripsy (ESWL) due to left sided urinary lithiasis. 20 hours later he presented with left lower quadrant abdominal pain. Investigations: Ultrasound examination revealed free intraabdominal air and free perisplenic fluid. An injury of the left kidney could be excluded. Treatment and course: Due to increasing abdominal pain a laparoscopy was performed, revealing a faecal peritonitis. Since no perforation could be detected laroscopically, a laparotomy was performed, demonstrating a perforation of the descending colon. The perforation was oversewn, a defunctioning colostomy was not performed. Postoperatively the patient had an uncomplicated hospital stay and was discharged home on postoperative day 8. Conclusion: ESWL is considered a safe method to treat urinary lithiasis with a low complication rate, Nevertheless serious potentially life-threatening pararenal complications can occur. Due to the increasing number of outpatient procedures, a careful clinical and ultrasound monitoring of the patient with early recognition and interdisciplinary management of complications is necessary after each ESWL therapy.