巨大腎水囊合併腎臟游離之案例 : 病例報告與文獻回顧
A case of giant renal cyst with migrating kidney: a case report and review of literature
Chou Chen-wei, Leonard S. Chuech, Tu Yuan-po, Hsu Fu-shun
Department of Urology, New Taipei City Hospital, New Taipei City, Taiwan
Simple renal cysts are among the most common cystic lesions of the kidney. Most benign renal cysts are asymptomatic and require only observation. However, rarely these cysts may become huge in size and result in significant symptoms. Cases of huge renal cysts have been rarely reported. Thus, we reported a 74-year-old female who presented with repeat urinary tract infection and massive abdominal distention. After control of infection, surgical intervention with hand-assisted laparoscopic renal cyst unroofing was performed.
A 74-year-old female visited emergent department due to right flank pain and fever for days. Initially, acute pyelonephritis was suspected because of pyuria. She was then admitted to urologic department for further management. On physical examination, right flank knocking and massive abdominal distention were noted. The distended abdomen was soft and elastic texture.
A CT scan was arranged and revealed a huge well-defined cystic lesion occupying almost two-third of abdominal cavity, displacing left kidney to right side. The cystic lesion measured 32 x 24 cm in size. Surgical intervention was advised in view of the significant cyst in size and internal organ compression.
The operation began with 7–cm midline incision above the umbilicus. A small hole of cystic wall was created and more than 6 L of yellowish clear fluid was drained. The hand-assisted device was placed in midline wound. While other two 10-mm trocar were placed in left lower abdomen and left anterior axillary line subcostally. The membrane of cyst was dissected as much as possible. Nephropexy was done to attach migrating left kidney to the back of the abdominal wall.
The postoperative course was uneventful and the patient was discharged 3 days after the operation. Intravenous urography done 3 months later showed normal kidney position and bilateral patent ureters.
A huge renal cyst measuring more than 15 cm is an extremely rare. Cases presenting simply with progressive abdominal distention can lead to misdiagnosis, such as obesity or ascites. In our case, huge left renal cyst caused left kidney migration to right side, leading to initial misdiagnosis of right acute pyelonephritis. Surgery has been considered the mainstay of treatment for giant cyst. We performed hand assisted laparoscopic renal cyst unroofing and nephropexy with uneventful postoperative course and good outcome.