a 45year  old woman was admitted to our hospital and surgery was planned for right staghorn calculus ( figure 1 ) .
ultrasound showed multiple calculi in the right kidney ; 38 mm in the pelvis , 21 mm in the lower pole and 16 mm in the upper pole with moderate hydronephrosis .
intravenous urography showed right renal staghorn calculus with delayed excretion suggestive of impaired right renal function .
ray showing the burden of calculi in the right kidney . under general anesthesia , initial ureteric
the procedure was carried out with the patient in prone position using a c  arm and bull 's eye technique .
lower pole puncture was done and the stones in the lower calyx , middle calyx and pelvis were cleared .
an upper pole puncture was done under c  arm guidance and bile was observed gushing out of the needle when the stiletto was removed .
a 20 fr foley catheter was kept as a percutaneous nephrostomy tube and the patient was put on antibiotics according to urine culture and sensitivity along with metronidazole . in the immediate post operative period , the patient was closely monitored with parameters such as pulse rate , blood pressure , abdominal girth monitoring , water balance and nasogastric tube aspirate .
the patient had two episodes of vomiting in the immediate post operative period and mild distension of the abdomen .
an ultrasound was performed twenty four hours after surgery and revealed minimal collection in the gall bladder fossa ( < 10 ml ) with pelvic collection ( < 50 ml ) .
a 72 hour scan was done which showed resolution of the gall bladder fossa collection .
the patient had no signs of peritonitis and responded well to conservative line of management .
she was discharged home on post operative day five and was followed up after two weeks with renal function test and liver function tests which were within normal limits . according to clavien dindo grading system for surgical complications this case fits into grade 2 .
percutaneous nephrolithotomy is the treatment of choice for large ( > 2 cm ) renal staghorn calculi [ 1 , 2 ] .
it constitutes a small number of all complicated visceral injuries during pcnl . till date , only six cases have been documented in literature .
other organ injuries such as spleen , liver and colon have been documented , with gall bladder injuries being the least common .
a well distended gall bladder is in close proximity to the right kidney and medial right  sided percutaneous renal access may increase the risk of gallbladder injury .
it is significant to bear in mind that gall bladder injury is not a common complication but is still commonly encountered in thin individuals .
most of the cases in the literature have undergone immediate cholecystectomy . in our case ,
pcnl was not abandoned and the patient did not undergo cholecystectomy ; our case was instead managed conservatively . in the post operative period , close monitoring is required , both clinical and by means of ultrasound .
if there is deterioration in the clinical scenario , then immediate cholecystectomy has to be done . in our case ,
the leak subsided and spontaneous closure of perforation occurred , most probably due to the use of a two piece diamond tip needle , which is supposed to be less traumatic as compared to other conventional needles .
 percutaneous nephrolithotomy ( pcnl ) has been an excellent option for the management of kidney stones . 
 there have been many complications in regards to solid organ injury during pcnl . 
 here we discuss an interesting case of 45-year - old woman , who underwent pcnl for right renal staghorn calculus , and had an accidental puncture of the gall bladder . 
 post operatively , the patient was conservatively managed and recovered well . a small number of cases has been reported until now in literature . 