Small bowel perforation and peritonitis: a rare life-threatening complication of extracorporeal shock wave lithotripsy (case report)

Extracorporeal shock wave lithotripsy (ESWL) is a cornerstone non-invasive therapy for urolithiasis. While major complications are rare, bowel perforation represents a serious life-threatening event. We present the case of a 36-year-old male with a history of recurrent renal stones who developed an acute abdomen four hours after supine ESWL for a right proximal ureteral calculus. Computed tomography revealed pneumoperitoneum and mesenteric stranding. Emergency laparotomy confirmed a jejunal perforation with secondary peritonitis, which was managed with primary repair and ureteral stenting. The patient made a full recovery. This case highlights a severe but rare complication of a common urological procedure. It underscores the critical need for high clinical suspicion in any patient presenting with abdominal pain post-ESWL, as prompt diagnosis via cross-sectional imaging and immediate surgical intervention are paramount for survival. A multidisciplinary approach is essential for optimal management.