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• W1987203438 abstract "A 53-year-old man presented with a painful right buttock and oliguria. He had hypertension, for which he took daily doses of ramipril 2.5 mg, hydrochlorothiazide 25 mg, diltiazem 90 mg, and aspirin 100 mg. One day before presentation he underwent right laparoscopic radical nephrectomy for renal cell carcinoma, which was performed uneventfully in the left flexed lateral decubitus position, and took 280 min to complete. On physical examination, the patient could not stand up or walk without support, and his right buttock and upper thigh were swollen, hard, and tender to touch. On admission, he weighed 85 kg with a body mass index of 30.1 kg/m2, and his serum creatinine was 6.1 mg/dl. A magnetic resonance imaging (MRI) scan (Figure 1) and a Tc-99m methylene diphosphonate (MDP) scintigraphy (Figure 2) were taken.Figure 2A Tc-99m MDP bone scintigraphy at the time of admission.View Large Image Figure ViewerDownload (PPT) What abnormalities do you observe on the radiologic studies? What is the cause of renal failure? Magnetic resonance imaging (Figure 1) showed diffuse swelling and heterogeneous abnormal high signal intensities in both gluteus minimus and medius muscles, likely from rhabdomyolysis. Tc-99m MDP bone scintigraphy (Figure 2) demonstrated bilateral extraosseous activity in both buttock areas (arrows). Further diagnostic testing revealed serum creatinine kinase level to be 35,430 U/l (normal, <220 U/l), serum myoglobin 1440.4 ng/ml (normal, 19–92 ng/ml), and serum aldolase 22.5 IU/ml (normal, <7.6 IU/ml), thus confirming the diagnosis of rhabdomyolysis. Rhabdomyolysis is most frequently a complication of trauma from crush injuries, but may be associated with non-traumatic conditions such as prolonged muscle ischemia or the adverse advents of some drugs.1.Irvine J. Aho T. Davidson P. et al.Rhabodomyolysis following laparoscopic radical nephrectomy: a case to heighten awareness.Nephrology. 2006; 11: 282-284Crossref PubMed Scopus (12) Google Scholar Rhabdomyolysis with acute renal failure is a rare but serious complication in patients who undergo laparoscopic surgery. It has been reported that certain surgical positions such as the ‘kidney rest lateral decubitus position’ (Figure 3) not only cause muscle compression at pressure point, but a significant reduction in cardiac output and mean arterial pressure during the procedure.2.Yokoyama M. Ueda W. Hirakawa M. Haemodynamic effects of the lateral decubitus position and the kidney rest lateral decubitus position during anaesthesia.Br J Anaesth. 2000; 84: 753-757Crossref PubMed Scopus (32) Google Scholar Both these factors can lead to muscle ischemia and subsequent rhabdomyolysis.3.Reisiger K.E. Landman J. Kibel A. et al.Laparoscopic renal surgery and the risk of rhabdomyolysis: diagnosis and treatment.Urology. 2005; 66: 29-35Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar The major risk factors for rhabdomyolysis following laparoscopic nephrectomy include exaggerated intraoperative positioning, extreme muscular build or morbid obesity, prolonged operation time, pre-existing hypertension, previous renal dysfunction, diabetes and intraoperative hypovolemia, or hypotension.3.Reisiger K.E. Landman J. Kibel A. et al.Laparoscopic renal surgery and the risk of rhabdomyolysis: diagnosis and treatment.Urology. 2005; 66: 29-35Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar In this case, the T2-MRI revealed diffuse swelling and high signal intensities in gluteus muscles (Figure 1). Tc-99m MDP bone scintigraphy demonstrated bilateral extraosseous activity in both buttock areas (Figure 2). After four sessions of hemodialysis, the patient's renal function gradually recovered. Two months later, the patient could walk normally and his serum creatinine level was normal. Follow-up MRI revealed normal signal intensities in gluteus muscle (Figure 4a), and a Tc-99m MDP bone scintigraphy showed no extraosseous activity in both buttock areas (Figure 4b).Figure 4Follow-up T2-weighted, transverse MRI image and Tc-99m MDP bone scintigraphy. (a) MRI image showed normal signal intensities in both gluteus muscles. (b) A Tc-99m MDP bone scintigraphy demonstrated no extraosseous activities in both buttock areas.View Large Image Figure ViewerDownload (PPT) In conclusion, patients with acute renal failure after laparoscopic nephrectomy should be screened for rhabdomyolysis, especially if the patient is morbidly obese or extremely muscular, and if operative time is prolonged. Proper padding of the operative table, minimizing operation time and intraoperative hypovolemia may help to prevent or minimize this serious complication." @default.
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• W1987203438 date "2008-01-01" @default.
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• W1987203438 title "The Case ∣ Acute renal failure after laparoscopic nephrectomy" @default.
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• W1987203438 doi "https://doi.org/10.1038/sj.ki.5002698" @default.
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