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首页> 外文期刊>Cases Journal >Infarction of middle third posterior cortex of kidney: a complication of extended pyelolithotomy, intra-operative electrohydraulic lithotripsy and extraction of calyceal stones under vision using stone basket and flexible cystoscope in a spinal cord injury patient – a case report
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Infarction of middle third posterior cortex of kidney: a complication of extended pyelolithotomy, intra-operative electrohydraulic lithotripsy and extraction of calyceal stones under vision using stone basket and flexible cystoscope in a spinal cord injury patient – a case report

机译：肾中后第三中层梗死：在脊髓损伤患者的视野下，使用石篮和柔性膀胱镜在扩大的肾盂切开术，术中电液碎石术和肾盂结石摘除的并发症–病例报告

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Background Spinal cord injury produces multiple systemic and metabolic alterations. A decrease in micro vascular blood flow to liver, spleen and muscle has been described following spinal cord injury. Case presentation We present a 46-year-old male patient with C-4 complete tetraplegia, who developed a large stag horn calculus with branches in upper, middle and lower calyces of left kidney. This patient underwent Gil-Vernet extended pyelolithotomy and required intra-operative electrohydraulic lithotripsy and retrieval of stones from upper, middle and lower calyces using flexible cystoscope and stone basket. Computed tomography, performed eighteen days after surgery, showed multiple areas of non-enhancing cortex posteriorly and in the upper pole, suggestive of focal infarction. Magnetic resonance imaging of left kidney confirmed the presence of an area of infarction in middle third of posterior cortex, but there was no evidence of trauma to posterior division of renal artery. Therefore, we postulate that compression of renal parenchyma by Gil-Vernet retractors during surgery, and firm pressure that was applied over the middle of kidney for prolonged periods while several attempts were being made to retrieve fragments of calculi from renal calyces, led to ischaemia and subsequently, infarction of mid-third posterior cortex of left kidney. Conclusion This case illustrates importance of gentle handling of kidney during extended pyelolithotomy in order to prevent subtle renal trauma, which may be detected only by advanced imaging studies. Further, spinal cord physicians should take a pragmatic approach to management of stones located inside renal calyces. Both spinal cord injury patients and their physicians should remember that in our enthusiasm to achieve complete clearance of stones embedded deeply within renal calyces, we could produce irreversible injury to kidney, as indeed happened in this patient. Therefore, emphasis should be placed on prevention of struvite renal calculi by discarding indwelling urinary catheters and eliminating Proteus bacteriuria.
机译：背景脊髓损伤会产生多种全身和代谢改变。脊髓损伤后，已经描述了流向肝脏，脾脏和肌肉的微血管血流量减少。病例介绍我们介绍了一位C-4完全性四肢瘫痪的46岁男性患者，该患者发展出一个大型的角鹿角结石，在左肾的上，中，下肾小管中都有分支。该患者接受了Gil-Vernet扩大的肾盂切开术，需要术中进行电液压碎石术，并使用柔性膀胱镜和结石篮从上，中，下肾盏取回结石。术后十八天进行的计算机断层扫描显示，后部和上极皮层有多个未增强的区域，提示有局灶性梗塞。左肾的磁共振成像证实在后皮层中部存在梗塞区域，但是没有证据显示肾动脉后段受到损伤。因此，我们假设在手术期间由Gil-Vernet牵开器压迫肾实质，并且长时间尝试在肾脏中部施加稳固的压力，同时进行了几次尝试从肾盏中取回结石的碎片，从而导致局部缺血和随后，梗塞左肾后三叶中段。结论该病例说明在延长的肾盂切开术中轻柔地操作肾脏对于预防细微的肾脏损伤的重要性，只有通过高级影像学检查才能发现。此外，脊髓内科医师应采取务实的方法来处理肾盏内的结石。脊髓损伤患者和他们的医生都应该记住，在我们完全清除深深埋在肾盏内的结石的热情中，我们可能会对肾脏造成不可逆转的损伤，这确实发生在该患者身上。因此，应着重通过丢弃留置导尿管和消除变形杆菌细菌来预防鸟粪石肾结石。

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