Renal transplant torsion

Case contributed by Dra. Mónica Mariana Azor

Presentation

Patient presented to the consultation three months after kidney and pancreatic transplantation due to mild pain in the left iliac fossa and oliguria/anuria.

Patient Data

Age: 30 years
Gender: Male
Ultrasound

In the ultrasound images, the transplanted kidney can be seen in the left iliac fossa with a globular appearance. When applying color Doppler, no arterial or venous vascularization is observed. The ultrasound operator also notes that the graft position is pelvic.

CT

Tomographic images confirm the pelvic position of the kidney graft and its lack of vascularization. The images without enhancement show the hyperdensity of the venous vascular structures of the transplanted kidney. In the angiographic phase, an abrupt stop is shown in the graft artery at the proximal level. In the venous phase, no improvement has yet been observed with contrast.

Case Discussion

Torsion has been described to occur as early as postoperative period, like this case, to as long as 10 years postoperatively. Once recognized, treatment involves immediate detorsion in the operating room. Rates of graft salvage after detortion are approximately 44% 1.

In the exploratory laparotomy, the kidney with a violated appearance and a torsion of the vascular pedicle were observed. The graft is repositioned. An improvement in color and pulse in the renal artery was achieved to the touch (papaverine is added) and to the color Doppler image, so it was decided to leave the kidney implanted.

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Case information

rID: 83419
Published: 25th Oct 2020
Last edited: 30th Oct 2020
System: Urogenital
Inclusion in quiz mode: Included
Institution: HOSPITAL ESPAÑOL DE MENDOZA

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