Recurrent clot anuria following laparoscopic pyeloplasty in a solitary functioning kidney: managing with double guide wire technique

Abstract

Clot anuria in a solitary functioning kidney is an emergency situation. Haematuria with clot anuria in an early postoperative period represents a challenge, as treatment options are limited. Manipulation of the anastomotic site may lead to anastomotic disruption and urinoma while use of thrombolytic therapy poses the danger of increasing haematuria. We report a case of anuria due to clot retention in the upper tract following laparoscopic dismembered pyeloplasty in a solitary functioning kidney, managed successfully with double guide wire technique.

Spontaneous common bile duct perforation due to choledocolithiasis accompanied with pancreaticobiliary maljunction in an adult: a case report

“…Either weakness in the wall of the bile duct or an increase in intraductal pressure or both have been suggested as the cause of the perforation [ 11 ]. Fragility of the bile duct wall is considered to be caused by choledochal cysts [ 14 , 15 ], pancreatitis [ 15 , 16 ], chronic infection [ 12 ], congenital weakness [ 11 ], ischemia [ 11 ], pancreatic reflux [ 11 ], and torsion of the gallbladder [ 11 ]. In contrast, reported causes of perforation with increased intraductal pressure include biliary sludge or stones [ 1 – 10 ], tumors [ 11 ], congenital stenosis of the ampulla of Vater [ 11 ], spasm of sphincter of Oddi [ 11 ], protein plugs [ 11 ], and parasites [ 11 ].…”

“…CBD perforation associated with pregnancy was observed in seven cases (30.4%), and all but one case developed in the third trimester. Although the relationship between pregnancy and CBD perforation is unclear, hemodynamic changes associated with higher pressure in the vena cava [ 2 ], raised intra-abdominal pressure [ 15 ], or global arteriolar spasm and impaired microcirculation due to preeclampsia [ 8 ] were mentioned as causes.…”

Editorial Comment to Blood clots evacuation from the renal pelvis: How to perform it?

“…Obstructive blood clots can form in the renal pelvis after some kinds of surgeries, including percutaneous nephrolithotomy, pyeloplasty, retrograde intrarenal surgery and ureteral stent insertion . The increasingly common use of pharmacological thromboprophylaxis after surgery can also promote bleeding and clotting.…”

“…Kumar et al . described the management of recurrent clots after laparoscopic pyeloplasty in a solitary functioning kidney . They placed two guidewires alongside the ureteral stent to form multiple crevices along the ureteric lumen resulting in the drainage of urine.…”