經皮穿腎取石術後產生的腎假性動脈瘤診斷及治療

潘綱凡、李淑文、蕭毅君、賴昱維、黃建榮、薛又仁

台北市聯合醫院仁愛院區 外科部 泌尿外科

Diagnosis and Treatment of Renal Pseudoaneurysm Found

After  Percutaneous Nephrolithotomy

Gary K. Pan, Shu-Wen Li, Yi-Chun Hsiao, Yu-Wei Lai, Andy C. Huang, Thomas Y. Hsueh

Division of Urology, Department of Surgery, Taipei City Hospital renai Branch, Taipei,

Purpose:

Renal pseudoaneurysm is a rare vascular lesion,which often occurred after renal trauma,surgery and even  percutaneous procedures.Unstable defect of arterial wall led to rupture of pseudoaneurysm and could be life threatening.We presented a 56 y/o male had renal pseudoaneurysm after we treated his left renal stone by percutaneous nephrolithotomy.

Case presentation:

A 56 y/o male had persistent hematuria for 3 three weeks after percutaneous nephrolithotomy.Therefore,he was admitted again for survey.

After admission, pre-op survey was arranged. There was no contraindication for left URS + DJ replacement. Thus, the procedure was done smoothly and the patient stood the whole procedure well. Transamin 50mg ivd Q6H + Phytonadione 10mg QD was added for stop bleeding. We also prescribed seforce 400mg Q12H ivd as empirical antibiotics. However, massive gross hematuria was still noted with foley obstruction caused by blood clot. Toomey irrigation was performed. For further evaluation of bleeding site, abdomen CTA was arranged and showed contrast leak at left lower lobe of kidney, suspect pseudoaneurysm. Thus, after well explanation the benefit and risk of transcatheter arterial embolization(TAE), the patient agreed. Due to the poor renal function (eGFR:35.260), pre and post TAE hydration with N/S was given. TAE was performed on 112/2/21. No obvious complaint for discomfort was noted. Under stable clinical condition, the patient was discharged and arranged OPD follow up.

Conclusion: 

Renal pseudoaneurysm could happen after open, endovascular or percutaneous renal surgery despite its low incidence. Symptoms  included pain, hematuria and hypertension,or even asymptomatic.Surgeon should always keep it in mind and found it quickly so that we could treat it in time.