Conservative treatment of acute traumatic left renal vein occlusion: Importance of left gonadal vein, case report
| Autor: | Kyoung Hoon Lim, Hyung Jun Kwon |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Traumatic
medicine.medical_specialty medicine.medical_treatment Left renal vein urologic and male genital diseases Revascularization Inferior vena cava Article 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Occlusion medicine Acute occlusion Vein Creatinine business.industry Trauma center Nephrectomy Surgery medicine.anatomical_structure medicine.vein chemistry 030220 oncology & carcinogenesis cardiovascular system Collateral 030211 gastroenterology & hepatology Gonadal vein business |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| DOI: | 10.1016/j.ijscr.2020.03.016 |
| Popis: | Highlights • A blunt renal injury commonly leads to thrombotic partial renal infarct, but only rarely to an isolated acute renal vein occlusion. • The surgical approach of thrombosed renal vein for preserving the kidney is likely to be an extensive operation, otherwise nephrectomy. • Collateral pathway of the left renal venous drainage may be well known to urologists, but may be unfamiliar to trauma surgeons. • If the gonadal vein is patent, left renal vein occlusion could be treated conservatively. Introduction Isolated acute traumatic renal vein occlusion is rare. As both kidneys have limited capsular and peripelvic vein collaterals, acute renal vein occlusion could lead to renal infarction. However, the left renal vein has potential collateral pathways through the gonadal vein. Presentation of case A 56-year-old woman was transferred to our trauma center after a pedestrian accident. Computed Tomography (CT) with contrast enhancement showed that no delineation of left renal vein with adjacent retroperitoneal hematoma around renal vessels, but left renal venous flow was being drained through left gonadal vein, therefore, left kidney was not congested. Her serum creatinine concentration was normal. We elected to treat her left renal vein occlusion conservatively because of the collateral pathway into the gonadal vein. Discussion Collateral pathway of the left renal venous drainage may be well known to urologists or vascular surgeons, but may be unfamiliar to trauma surgeons. Therefore, trauma surgeon’s attempts for revascularization of thrombosed left renal vein may lead to massive bleeding or nephrectomy. Conclusion Acute left renal vein occlusion close to the inferior vena cava can result in temporary venous hypertension and congestion followed by complete or nearly complete return of function as collateral veins enlarge. If the gonadal vein is patent, left renal vein occlusion could be treated conservatively. |
| Databáze: | OpenAIRE |
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