Percutaneous endoscopic renal surgery is usually a safe and effective treatment for patients with complex renal calculi, tumors of the collecting system, and ureteropelvic junction obstruction. A unique set of complications, however, can occur with this surgical approach that may involve the targeted kidney and surrounding structures. Bowel injuries represent a very rare complication. Methods of preventing colonic and small intestine injuries, diagnosing their occurrence, and management strategies are reviewed in this article.