Limits...
Supernumerary kidney presenting as urinary leakage after an ipsilateral laparoscopic radical nephrectomy.

Roslan M, Markuszewski MM, Kułagin A, Markuszewski MR, Połom W, Krajka K - Cent European J Urol (2012)

Bottom Line: We present a case of a patient with supranumerary kidney diagnosed after laparoscopic radical nephrectomy.The latter right nephrectomy was performed.Despite the scarceness of this anomaly, a thorough interpretation of images obtained during investigative procedures can provide a clue about the presence of this rare entity.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Medical University of Gdańsk, Gdańsk, Poland.

ABSTRACT
We present a case of a patient with supranumerary kidney diagnosed after laparoscopic radical nephrectomy. Urinary leakage, an unusual complication that appeared postoperatively, led to complementary examination and making the right diagnosis. The reevaluation of the preoperative CT (computed tomography) in enhancement phase and the new CT scan confirmed the presence of a real accessory organ connected to the main unit with a small bridge of tissue. The latter right nephrectomy was performed. Despite the scarceness of this anomaly, a thorough interpretation of images obtained during investigative procedures can provide a clue about the presence of this rare entity.

No MeSH data available.


Related in: MedlinePlus

Preoperative computed tomography (CT) scans indicating a solid mass in the right kidney – frontal image.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3921760&req=5

Figure 0001: Preoperative computed tomography (CT) scans indicating a solid mass in the right kidney – frontal image.

Mentions: A 62-year-old man was admitted to our hospital with non-palpable solid mass in his right kidney. The patient presented no significant symptoms except for mild arterial hypertension. A chest X-ray and abdomen computed tomography (CT) were carried out and the presence of organ confined 56-mm in diameter right renal tumor was confirmed. Before the treatment the only available CT images were frontal and horizontal (Fig. 1a, b). The diagnosis seemed to be clear. The patient was qualified for transperitoneal laparoscopic radical nephrectomy (LRN) and operated on with a standard manner under general anesthesia. The operation was performed by an experienced laparoscopic surgeon. The right renal hilar vessels were transected with the endovascular stapler. Some metal clips were used to secure smaller vessels and the ureter. The adrenal gland was partly excised with harmonic scalpel. The adipose capsule above the upper pole was thin and the fibrous capsule was strongly fixed to the surrounding tissue, so the dissection was very delicate and time-consuming. Because of the difficulties during the upper pole separation, the operation time was lengthened by up to 200 minutes. In this phase an increased amount of bleeding was also observed (total blood loss was 1100 ml). The 15-mm EndoCatch was used for intact kidney removal and the drainage tube was left in the subhepatic area. The histopathological examination revealed renal cell carcinoma (RCC – subtype clear cell, Fuhrman G2) within intact renal capsule (pT1bN0). No intra- nor perioperative complications were observed. The drainage tube was removed on postoperative day 3, despite the fact that 150 ml of yellow fluid was collected daily. This fluid was considered peritoneal liquid and the patient was discharged on the same day. After 2 days the patient was readmitted because of strong lumbar pain, shivers and fever. The ultrasound exam showed a nonechoic space located in the subhepatic area, in the right lumbar region. The peristalsis was proper and laboratory findings were normal except for the increased serum leukocyte level. The subhepatic abscess was diagnosed and percutaneous drainage was performed and 300 ml of pus was collected and examined. The therapy with fluoroquinolone was introduced according to the microbiology finding. The patient's condition improved rapidly and he was discharged home after 3-day hospitalization with recommendation to measure the daily amount of collected fluid.


Supernumerary kidney presenting as urinary leakage after an ipsilateral laparoscopic radical nephrectomy.

Roslan M, Markuszewski MM, Kułagin A, Markuszewski MR, Połom W, Krajka K - Cent European J Urol (2012)

Preoperative computed tomography (CT) scans indicating a solid mass in the right kidney – frontal image.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921760&req=5

Figure 0001: Preoperative computed tomography (CT) scans indicating a solid mass in the right kidney – frontal image.
Mentions: A 62-year-old man was admitted to our hospital with non-palpable solid mass in his right kidney. The patient presented no significant symptoms except for mild arterial hypertension. A chest X-ray and abdomen computed tomography (CT) were carried out and the presence of organ confined 56-mm in diameter right renal tumor was confirmed. Before the treatment the only available CT images were frontal and horizontal (Fig. 1a, b). The diagnosis seemed to be clear. The patient was qualified for transperitoneal laparoscopic radical nephrectomy (LRN) and operated on with a standard manner under general anesthesia. The operation was performed by an experienced laparoscopic surgeon. The right renal hilar vessels were transected with the endovascular stapler. Some metal clips were used to secure smaller vessels and the ureter. The adrenal gland was partly excised with harmonic scalpel. The adipose capsule above the upper pole was thin and the fibrous capsule was strongly fixed to the surrounding tissue, so the dissection was very delicate and time-consuming. Because of the difficulties during the upper pole separation, the operation time was lengthened by up to 200 minutes. In this phase an increased amount of bleeding was also observed (total blood loss was 1100 ml). The 15-mm EndoCatch was used for intact kidney removal and the drainage tube was left in the subhepatic area. The histopathological examination revealed renal cell carcinoma (RCC – subtype clear cell, Fuhrman G2) within intact renal capsule (pT1bN0). No intra- nor perioperative complications were observed. The drainage tube was removed on postoperative day 3, despite the fact that 150 ml of yellow fluid was collected daily. This fluid was considered peritoneal liquid and the patient was discharged on the same day. After 2 days the patient was readmitted because of strong lumbar pain, shivers and fever. The ultrasound exam showed a nonechoic space located in the subhepatic area, in the right lumbar region. The peristalsis was proper and laboratory findings were normal except for the increased serum leukocyte level. The subhepatic abscess was diagnosed and percutaneous drainage was performed and 300 ml of pus was collected and examined. The therapy with fluoroquinolone was introduced according to the microbiology finding. The patient's condition improved rapidly and he was discharged home after 3-day hospitalization with recommendation to measure the daily amount of collected fluid.

Bottom Line: We present a case of a patient with supranumerary kidney diagnosed after laparoscopic radical nephrectomy.The latter right nephrectomy was performed.Despite the scarceness of this anomaly, a thorough interpretation of images obtained during investigative procedures can provide a clue about the presence of this rare entity.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Medical University of Gdańsk, Gdańsk, Poland.

ABSTRACT
We present a case of a patient with supranumerary kidney diagnosed after laparoscopic radical nephrectomy. Urinary leakage, an unusual complication that appeared postoperatively, led to complementary examination and making the right diagnosis. The reevaluation of the preoperative CT (computed tomography) in enhancement phase and the new CT scan confirmed the presence of a real accessory organ connected to the main unit with a small bridge of tissue. The latter right nephrectomy was performed. Despite the scarceness of this anomaly, a thorough interpretation of images obtained during investigative procedures can provide a clue about the presence of this rare entity.

No MeSH data available.


Related in: MedlinePlus