Post-traumatic urinomas are well-described complications associated with the nonoperative management of major blunt renal injuries. A 16-year-old male sustained a motor vehicle accident. Brought after 30 minutes to emergency department, upon arrival he was fully conscious, complaining of severe right hypochondrial and loin pain, abdomen was tender and guarded over the right side, urinary catheter inserted revealed gross haematuria, the patient was resuscitated accordingly, fast ultrasound scan showed minimal fluid collection in the Morison's pouch, the right kidney was swollen with perinephric fluid collection and poor cortico-medullary differentiation. Urgent CT scan findings were deep avulsion of the right kidney. The Patient was planned for conservative management, admitted to high dependency ward, CT scan repeated, and the size of urinoma increased compared to the initial CT, so he was planned for retrograde pyelography and ureteric stenting. Intra-operatively the right ureter was canulated, contrast injected. The pelvi-ureteric junction was intact, extravasation of contrast in the upper pole of the kidney. The right ureter was stented using a size 6 multiloop stent, with the tip directed into the upper pole calyx. The Patient showed dramatic improvement, haematuria cleared and the patient was discharged well after 12 days and the stent was removed after 6 weeks. Despite the improvements with nonoperative management, complications are described and include delayed hemorrhage, delayed massive hematuria and renal scaring with loss of function. Ureteric stenting is playing a major part in the conservative management of high-grade renal injury particularly grade IV type.

Open partial nephrectomy, or nephron-sparing surgery (NSS), is now considered as the standard for small renal tumors treatment. The oncologic efficacy and safety of NSS for the treatment of stage-T1a renal tumors have been repeatedly demonstrated to be equivalent to radical nephrectomy. A 66-year-old gentleman chronic smoker was incidentally found to have a small mid pole lesion in the left kidney on routine ultrasound scan, CT finding was 2x2 cm mid pole tumor, no involvement or metastasis, the patient given the option of partial nephrectomy. In surgery, the left kidney was explored, and the tumor mass was seen to occupy the mid pole. The mid pole branch of the renal artery was clamped after cooling the kidney with ice slush following 300cc of 20% mannitol infusion. In-situ nephron-sparing left nephrectomy was done with a margin of 1cm minor upper calyceal injury repaired. The patient was discharged five days postoperative. Gross examination of the specimen revealed a wedge biopsy of the mid pole with attached perinephric fat with swelling part at the outer surface, pushing the capsule. Microscopic sections show a well-defined tumor mass in the renal parenchyma, surrounded by a fibrous capsule, composed of a multilocular cystic area lined by malignant cells. NSS initially was reserved for patients with solitary kidneys, tumors, and those with significant comorbidities predisposing to future renal failure; indications have expanded recently to allow elective partial nephrectomy in the setting of a normal contralateral kidney.

Usually, the Jejunal diverticula appeared multiple and vary in size. These false diverticula lack the muscular coat of the normal intestinal walls, and most patients presented with it were asymptomatic. Although 10% of all patients develop complications such as perforation, obstruction, or bleeding, which then requires surgical intervention, but bleeding is relatively rare among these complications. A case of 74 years old lady was referred to our hospital because of persistent hematemesis and fresh melena. Her previous and recent upper gastrointestinal endoscopy both revealed only gastric erosions without any active bleeding. Also, previous, and recent colonoscopy was done but not completed due to the presents of fresh blood and blood clots along the colon, which led to improper visualization. Her selective mesenteric angiography was done together with upper and lower endoscopy, but none of them revealed the source of bleeding. Emergency exploratory laparotomy was undertaken, and a prominent single jejunal diverticulum with a prominent vessel entering it was noted, and no bleeding from other sites detected. Enterotomy was performed, and enteroscopy confirmed ulceration at the jejunal diverticulum site. Resection of the portion containing the diverticulum and primary anastomosis was done, and this cured the patient. The histopathological examination of the specimen showed an ulcerative lesion with an exposed vessel suggestive of the source of bleeding. Although jejunal diverticula incidence is rare, it is important to look for such lesions in patients with intestinal bleeding. Keywords: jejunal diverticulum, small intestine, intestinal bleeding.