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Severe Hemorrhage after Extracorporeal Shock-Wave Lithotripsy

Marshall L. Stoller, MD; Lawrence Litt, PhD, MD; and Robert G. Salazar, MD
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Requests for Reprints: Lawrence Litt, PhD, MD, Anesthesia Department, UCSF, Room C-450, 521 Parnassus Avenue, San Francisco, CA 94143-0648.

Current Author Addresses: Dr. Stoller: Department of Urology, UCSF, Room U-518, 505 Parnassus Avenue, San Francisco, CA 94143-0254.

Dr. Litt: Anesthesia Department, UCSF, Room C-450, 521 Parnassus Avenue, San Francisco, CA 94143.

Dr. Salazar: Old Pueblo Anaesthia Group, 5700 East Pima Street, Suite E, Tucson, AZ 85712.

Ann Intern Med. 1989;111(7):612-613. doi:10.7326/0003-4819-111-7-612
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Extracorporeal shock-wave lithotripsy is now commonly used for the treatment of urinary calculi (1, 2). When first-generation lithotripters are used, epidural or general anesthesia is often provided to prevent pain (3). Newer lithotripters with improved shock-wave generators and better shock-wave focusing do not cause discomfort requiring anesthesia. Treatable complications of lithotripsy, other than complications associated with anesthesia alone, have been reported, including renal parenchymal disruption, subcapsular renal hematoma formation, and, rarely, cardiac dysrhythmias, pancreatitis, liver hematomas, and hemorrhage requiring blood transfusions (2, 4-7). We report two cases of severe hemorrhage soon after lithotripsy. The first patient, who was elderly and


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