Partial nephrectomy without vessel clamping and hypothermia with conservative management of post-operative bleed in a rural setup: a case report

Authors

  • Tushar Goel Department of General Surgery, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Haryana, India
  • Ravi Batra Department of Urology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Haryana, India
  • Kamal Sharma Department of Urology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Haryana, India

DOI:

https://doi.org/10.18203/2349-2902.isj20174529

Keywords:

Conservative management, Drain leak, Lower pole kidney mass, Partial nephrectomy, Post op bleed

Abstract

Hemorrhage is a well-known complication of partial nephrectomy. The bleeding is usually suspected when a patient presents with haematuria or bloody drain discharge following the procedure. This study’s primary objective is to discuss case of 63-year-old-man incidentally diagnosed with left lower pole kidney mass. USG abdomen was done and a suspicious mass in lower pole of kidney is noticed. CT-urography was done and assessment was made for further management. Patient details were collected by patient’s IPD file. Complete detailed history, patient vitals, hemogram, ABO, with USG abdomen and CT urography was done. Post op CT angiogram was done to evaluate for drain leak. Treatment diagnosis was left lower pole malignant mass. Pre-operative left ureteric catheter placement was done. 11th rib cutting incision was given. The tumour was resected with 1 cm margin. The renal defect was closed with interrupted sutures to the parenchyma. Gerota’s fascia was closed. A Robinson drain was placed and the abdominal wall closed. The case was managed without vessel clamping and hypothermia for clear renal cell carcinoma with post op bleed, successfully identified and managed conservatively, giving another potential management option in non-torrential haemorrhage. 

References

Israel GM, Hecht E, Bosniak MA. CT and MR imaging of complications of partial nephrectomy. Radiographics. 2006;26:1419-29.

Permpongkosol S, Link RE, Su LM, Romero FR, Bagga HS, Pavlovich CP, et al. Complications of 2,775 urological laparoscopic procedures: 1993 to 2005. J Urol. 2007;177:580-85.

Cohenpour M, Strauss S, Gottlieb P, Peer A, Rimon U, Stav K, et al. Pseudoaneurysm of the renal artery following partial nephrectomy: imaging findings and coil embolization. Clin Radiol. 2007;62:1104-9.

Fergany AF, Saad IR, Woo L, Novick AC. Open partial nephrectomy for tumor in a solitary kidney: experience with 400 cases. J Urol. 2006;175:1630-3.

Trehan A. Comparison of off-clamp partial nephrectomy and on-clamp partial nephrectomy: a systematic review and meta-analysis: Urol Int. 2014;93:125-34.

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Published

2017-09-27

Issue

Section

Case Reports