RESUMEN
Objetivos: Presentar el manejo mediante nefrectomía parcial e interposición del epiplón en casos de fístula urinaria en pacientes receptores de trasplante renal. Material y método: Presentamos un paciente con necrosis del polo inferior del injerto renal que afecta al sistema calicial, pero con la vascularización pieloureteral conservada, manejado de manera satisfactoria mediante nefrectomía parcial del segmento renal necrótico y sutura primaria del sistema colector con interposición del epiplón mayor. Realizamos una revisión de los casos de nefrectomía parcial en injerto renal descritos, analizando sus características y destacando la forma de presentación, los métodos diagnósticos, así como las técnicas quirúrgicas empleadas y sus resultados posteriores. Resultados: Existen pocos casos en la literatura contemporánea que describan un manejo quirúrgico conservador de las fístulas urinarias por necrosis segmentaria tras un injerto renal. El abordaje mediante nefrectomía parcial en estos casos presenta buen resultado en nuestra experiencia y en los casos descritos. Conclusiones: El manejo conservador de nefronas es factible y debería aplicarse en casos en los que la función renal previa y la cantidad de parénquima sano indiquen una correcta evolución posterior del injerto renal, a pesar de la evidente complejidad quirúrgica (AU)
Objectives: We present the management with partial nephrectomy and interposition of the greater omentum in case of urinary fistulas in renal allograft. Material and method: We present a patient with necrosis at the inferior pole of the renal graft that affected calyceal system but with pyeloureteral vascularization preserved. The patients condition was satisfactorily managed with a partial nephrectomy of the necrotic renal segment and primary suturing of the collecting system with interposition of the greater omentum. Were viewed the cases published to date of partial nephrectomy in renal allograft, and examined their outcomes by analyzing the patient presentation, diagnostic tools, and surgical techniques used. Results: There are few cases in the current literature that describe conservative surgical management of urinary fistulas caused by segmental necrosis after renal transplantation. Surgical approach using partial nephrectomy in these cases produces favorable outcomes in our experience and reported cases. Conclusions: Despite its obvious surgical complexity, this nephron-sparing management is feasible and should be implemented in cases where the prior renal function and the quantity of healthy parenchyma indicate a favorable subsequent evolution for the renal graft (AU)
Asunto(s)
Humanos , Fístula Urinaria/cirugía , Nefrectomía/métodos , Epiplón/cirugía , Trasplante de Riñón , Complicaciones Posoperatorias , Nefronas/cirugíaRESUMEN
OBJECTIVES: We present the management with partial nephrectomy and interposition of the greater omentum in case of urinary fistulas in renal allograft. MATERIAL AND METHOD: We present a patient with necrosis at the inferior pole of the renal graft that affected calyceal system but with pyeloureteral vascularization preserved. The patient's condition was satisfactorily managed with a partial nephrectomy of the necrotic renal segment and primary suturing of the collecting system with interposition of the greater omentum. We reviewed the cases published to date of partial nephrectomy in renal allograft, and examined their outcomes by analyzing the patient presentation, diagnostic tools, and surgical techniques used. RESULTS: There are few cases in the current literature that describe conservative surgical management of urinary fistulas caused by segmental necrosis after renal transplantation. Surgical approach using partial nephrectomy in these cases produces favorable outcomes in our experience and reported cases. CONCLUSIONS: Despite its obvious surgical complexity, this nephron-sparing management is feasible and should be implemented in cases where the prior renal function and the quantity of healthy parenchyma indicate a favorable subsequent evolution for the renal graft.