Gobishangar Sreekanthan, Shelton John
Department of Surgery, Faculty of Medicine, University of Jaffna, Sri Lanka.
Teaching Hospital Jaffna, Sri Lanka.
Int J Surg Case Rep. 2021 Nov;88:106514. doi: 10.1016/j.ijscr.2021.106514. Epub 2021 Oct 16.
INTRODUCTION & IMPORTANCE: Giant hydronephrosis (GH) is defined as a kidney containing greater than 1000 ml of urine in its collecting system. It is a rarely presented condition in an adult. Common aetiology for GH is due to congenital ureteropelvic junction obstruction. We present a case of a late presentation of GH was being managed by a minimally invasive laparoscopic technique.
A 63-year-old Sri Lankan male presented with worsening of generalized abdominal swelling with vague abdominal symptoms for a six-month duration, found to have a GH of the left kidney on USS. The Contrast-enhanced computerized tomography (CECT) scan confirmed the diagnosis with 12l of fluid and possible ureteropelvic junction obstruction (UPJO). CT did not show any excretion of the left kidney. Hydronephrosis was drained one day before the surgery by a percutaneous nephrostomy tube. Laparoscopic transperitoneal nephrectomy was performed. The patient had a smooth and fast recovery.
A neglected congenital UPJO can present with GH in adults. It causes vague abdominal symptoms like abdominal distension, dyspepsia, and fatigue. CECT will give the diagnosis and identify the aetiology of GH. Non-functional GH kidneys can be treated with nephrectomy by open or laparoscopic surgical technique. Laparoscopic nephrectomy shoes less blood loss during surgery, less postoperative pain and early recovery after surgery. However, in GH, surgeons need the experience to overcome the challenges like adhesions and working in a small space.
The percutaneous nephrostomy decompression followed by laparoscopic transperitoneal nephrectomy is feasible for a massive GH.
巨大肾积水（GH）定义为集合系统中尿液超过1000毫升的肾脏。这在成年人中是一种罕见的病症。GH的常见病因是先天性肾盂输尿管连接处梗阻。我们报告一例通过微创腹腔镜技术治疗的迟发性GH病例。
一名63岁的斯里兰卡男性因持续六个月的全身腹部肿胀加重及模糊的腹部症状就诊，超声检查发现左肾巨大肾积水。增强计算机断层扫描（CECT）扫描确诊为12升积液且可能存在肾盂输尿管连接处梗阻（UPJO）。CT未显示左肾有任何排泄。术前一天通过经皮肾造瘘管对肾积水进行引流。实施了腹腔镜经腹肾切除术。患者恢复顺利且迅速。
被忽视的先天性UPJO在成人中可表现为GH。它会引起如腹胀、消化不良和疲劳等模糊的腹部症状。CECT可做出诊断并确定GH的病因。无功能的GH肾脏可通过开放或腹腔镜手术技术行肾切除术治疗。腹腔镜肾切除术手术中失血较少，术后疼痛较轻且术后恢复较早。然而，对于GH，外科医生需要经验来克服如粘连和在狭小空间操作等挑战。
经皮肾造瘘减压后行腹腔镜经腹肾切除术对于巨大GH是可行的。
