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Abstract
Introduction/Background Pelvic and paraaortic lymphadenectomy is a major component of the surgical staging procedure for several gynecological malignancies. The removal of these lymph nodes needs expertise as there is a danger of the major vessel injury during the surgery. In this presentation We would like to report a case in which there was an accidental injury to the left renal vein during para-aortic lymphadenectomy.
Methodology Case: 42 years old patient referred to our clinic with abdominal mass and ascites. After systemic examination, imaging, paracentesis cytology with serous adenocarcinoma and tumor board decision the patient received three cycles of neo-adjuvant chemotherapy followed by interval debulking surgery. During paraaortic lymphadenectomy nearly half of left renal vein was accidentally ligated and cut with ultrasonic energy device. Left renal vein was retroaortic. After haemostasis we evaluate the renal circulation and was of the opinion that residual patency of the renal vein was not adequate for functioning of the left kidney.The stump of the damaged renal vein was tied, and the venous blood of the left kidney was diverted through an end to side anastomosis of the left gonadal vein with the venacava (figure 1). On the post operative period the patient was recovered quickly. Two months later her Tc-99 DMSA and other renal examinations was normal. She is presently well.
Anastomosis of left gonadal vein with vena cava
Results Retroaortic left renal vein is a normal anatomical variant and its recognition is important in order to avoid complications during retroperitoneal surgery. Management of complications in the literature is various. In our case report, using the gonadal vein as an alternative to the left renal vein saved the patient from nephrectomy.
Conclusion Gonadal vein graft for maintaining renal circulation can be a good alternative management in renal vein injuries.
Disclosure Nothing to disclose.