CC BY
15
II. ХИРУРГИЯ
LAPAROSCOPIC NEPHRECTOMY
OF THE GIANT HYDRONEPHROTIC KIDNEY.
CASE REPORT
Ibragimov R.P., Issayev D.A., Madadov I.K.
National Scientific Center of Surgery named after A.N. Syzganov, Almaty, Kazakhstan
Abstract
Clinical case of laparoscopic nephrectomy in a 25 years old patient with huge hydronephrotic kidney. At admittance patient complianted of pyrosis, fullness of stomach after a short meal, discomfort on the left flank. Despite huge dimensions laparoscopic surgery was considered. One of the most important aspects of surgery was the insertion of first troacar by the Hasson technique, under the visual guidance, because there was a probability for injury of intestine, which was drawn back laterally. After the successful placement of troacars pelvis was dissected, punctured and all liquid was aspirated, that was approximately 5 litres. Nephrectomy then was performed in a standard fashion, with no intraoperative complications.
МРНТИ 76.29.51.
ABOUT THE AUTHORS
R.P. Ibragimov - urologist, transplant-surgeon, head of kidney transplantation, urology and nephrology department.
D.A. Issayev - urologist, transplant-surgeon, kidney transplantation, urology and nephrology department. A
I.K. Madadov - urologist, kidney transplantation, urology and nephrology department.
Keywords
huge, hydroneprhosis, laparoscopy, nephrectomy.
Келем1 улгайган су буйректщ лапароскопиялык нефрэктомиясыньщ клиникалык окигасы
Ибрагимов Р.П., Исаев Д.А., Мададов И.К.
А.Н. Сызганов атында?ы Улттык, FbrnbiMè хирургия орталы^ы, Алматы, Казак,стан
Ацдатпа
25 жасташ наукастыц квлем1улеайеан сол жак буйректщ гидронефроздык трансформациямi бойынша жасалеан лапароскопиялык нефрэктомияныц клиникалык окиеасы сиппаталеан. Ауруханаеа тусер кездеп шашмдары туракты асказан кыжылы, аз квлемд1 тамак шкеннен кейн асказаннын толу сез1м1, сол жак бел аймашндаш дискомфорт. Буйректц улкен квлемдер1не карамастан лапарскопиялык ота жасау шеш1м1 кабылданды. Отаныц ец мацызды аспекттернц б1р1 ец б'рнш'! троакарды орнатканда Хассон техникасын колдану, квз бакылауы астында, вйткен1 iшектн латеральд1 шекте тартылуы мумкн. Астаушаныц диссекциясы жасалеан соц пункция жасалып шндеп су сорылып алынды, квлем15л. Нефрэктомия классикалык турде жасалынды, ота кезндеп аскынулары болеан жок.
АВТОРЛАР ТУРАЛЫ
Р. П. Ибрагимов - уролог-транспланто-логдэр1герI, буйрек трансплантациясы, урология шне нефрология 6ел1мшес1н1ц жетекшюI, еылыми жетекш1 (rava747@mail.ru 87017472070)
Д.А. Исаев - уролог-трансплантолог дэр1гер1, буйрек трансплантациясы, урология жэне нефрология бвл1мшес1 (dzhanibek@issayev.com 87477218977)
И.К. Мададов - уролог дэр1гер1, буйрек трансплантациясы, урология жэне нефрология бвл1мшес1, к01 еылыми кызметкер (dominic89@mail.ru 87478397110)
Туйш сездер
вте улкен, субуйрек, лапароскопия, нефрэктомия.
Лапароскопическая нефрэктомия гигантской гидронефротической почки. Клинический случай
Ибрагимов Р.П., Исаев Д.А., Мададов И.К.
Национальный научный центр хирургии им. А.Н. Сызганова, Алматы, Казахстан
Аннотация
Клинический случай лапароскопической нефрэктомии у пациентки 25 лет с огромной гидронефротической трансформацией левой почки. При поступлении пациентка предъявляла жалобы на постоянную изжогу, чувство переполнения желудка при приеме небольшого количества пищи, дискомфорт в пояснице слева. Несмотря на огромные размеры почки, было принято решение провести лапароскопическую операцию. Одним из основных моментов при операции была установка первого троакара по технике Хассона, под визуальным контролем, так как была вероятность повреждения кишечника, которая была дислоцирована латерально. После удачной установки троакаров была выделена лоханка и с помощью пункции была аспирирована жидкость около 5 л. Нефрэктомия была выполнена классически, без интраоперационных осложнений.
ОБ АВТОРАХ
Ибрагимов Р.П. - уролог - трансплантолог, заведующий отделением трансплантации почек, урологии и нефрологии, руководитель исследования. (rava747@mail.ru 87017472070)
Исаев Д.А. - уролог-трансплантолог, отделение трансплантации почек, урологии и нефрологии. (dzhanibek@issayev.com 87477218977)
Мададов И.К.- уролог, отделение трансплантации почек, урологии и нефрологии, младший научный сотрудник (dominic89@mail.ru 87478397110)
Ключевые слова
огромный, гидронефроз, лапароскопия, нефрэктомия.
Introduction
According to the previously published clinical cases, giant hydronephrosis usually occurs in children and are of congenital origin. It is rarely seen in adults, clinical presentation of which is very nonspecific mimicking gastrointestinal disorders and others, thus it is easy to be misdiagnosed [1].
In 1939, Stirling defined giant hydronephrosis as the presence of fluid exceeding 1,000 ml in the collecting system [1]. Now more than 600 cases have been reported worldwide to date, with most cases reported within the last 15 years [2].
Ureteropelvic junction (UPJ) obstruction is the most frequently revealed cause of hydronephrosis
Fig. 1.
Physical examination.
Left part of abdomen more prominent than the right part
with an estimated incidence of 1 in 1000-1500 [3]. Other causes including ureter calculous, transitional cell carcinoma of pelvis, squamous cell carcinoma of the renal pelvis or renal, ureteral ectopia, duplicated collecting system, renal malformations, polar or aberrant vessels have been described in adults [4-7]. In our hospital was a case of a giant hydronephrosis on the left due to transitional cell carcinoma in UPJ that was unfortunately diagnosed only after histologic evaluation. UPJ obstruction is mostly considered as a functional obstruction originating from abnormalities in the smooth muscle of the pelvis and ureter [8].
Even giant hydronephrosis has been reported over 600 cases, it is still not easy to differentially diagnosis. It usually presents with vague symptoms such as nausea, fatigue or dyspepsia, urinary tract infection, renal insufficiency, or gross hematuria after trauma in adults [9]. Giant hydronephrosis is a slowly progressive disease; patients may remain asymptomatic until late phase [10]. A wide range of differential diagnosis includes intraperitoneal, and retroperitoneal cysts, pseudomyxoma, renal tumor pancreatic pseudocysts, retroperitoneal tumor, and ovarian cysts or tumor [11]. The most important aspect of management is early diagnosis with accurate pre-operative delineation of anatomy of the affected kidney.
In our case patient had gastrointestinal disorders such as gastroesophageal reflux, fullness in stomach after a short meal. All the symptoms which were similar to the presentation of gastrointestinal disease can easily confound physician's diagnosis. Usually, it is not likely consider a giant hydronephrosis diagnosis firstly. Awareness of this situation, the clinician and radiologist could readily diagnose and provide appropriate therapy.
Nowadays, diagnostic instruments such as enhanced CT scans, antegrade or retrograde and excretory urographies, ultrasonography have facilitated the diagnosis of hydronephrosis, accurate diagnosis of giant hydronephrosis in individual cases is improved.
Aim of work - the presentation of a case of the laparoscopic nephrectomy of the giant hydrone-phrotic kidney.
Case presentation
A 25 years-old woman was admitted to the hospital with discomfort on the left flank, gastro-esophageal reflux, fullness in stomach after short meal. On physical examination left part of the abdomen was more prominent than the right half (Fig. 1). During palpation frank tenderness was noticed on the left part on the abdomen. On ultrasound huge anaechogenic structure on the left part of
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ВЕСТНИК ХИРУРГИИ КАЗАХСТАНА № 3-2018
the abdomen was revealed. The volume of the latter was approximately 5000ml. On CT scans huge hydroneprotic left kidney was detected (Fig. 2). The parenchyma was 3mm with no contrast uptake was seen.She underwent laparoscopic nephrectomy on the left in our department. Patient was on lateral decubitus position. Patient underwent laparoscopic nephrectomy: troacar placement was performed by the Hasson technique. Primarily lateral flank on
Toldt's line was transected and intestine was retracted medially thus exposing the kidney with it is surrounding tissue. Enlarged pelvis was dissected and all liquid was aspirated. Nephrectomy then was performed in a standard fashion.
Grossly removed kidney resembled deflated soccer ball (Fig. 3) On histologic examination hypertrophy of UPJ wall was detected. Patient was discharged on 4th postoperative day in a steady state.
References
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