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Rev Mex Urol. 2018 November-December;78(6):455-58 DOI: https://doi.org/10.24245/revmexurol.v78i6.2003
Axel F Mora-Ramírez,1 Rubén Gutiérrez-Rosales,1 Marco A Aragón-Castro,1 Christian Vázquez-Niño,1 Guillermo E Ruvalcaba-Oceguera,1 Aldo U Ordoñez-Jurado,1Miguel A Martínez-Arias2
1 Department of Urology.
2 Department of Thoracic Surgery.
Universidad Autónoma del Estado de México, Facultad de Medicina, División de Posgrados, Centro Médico ISSEMyM, Toluca, Estado de México.
BACKGROUND: Intrathoracic ectopia denotes a partial or complete protrusion of the kidney at the level of the diaphragm in the posterior mediastinum. It is the rarest form of renal ectopia.
CLINICAL CASE: A 39-year-old woman sought medical attention for fever of 39 ºC, dysuria, and colicky, stabbing, intermittent pain in the right lumbar region and hemithorax, nausea and vomiting, tachycardia, and hypotension. She had a personal history of high blood pressure of 10-year progression, pulmonary hypertension of 13-year progression, as well as the diagnosis of dextrocardia with situs inversus, since childhood. In 2005, the patient was diagnosed with right intrathoracic renal ectopia with a right diaphragmatic hernia. In relation to her current illness, the patient was admitted to the intensive care unit due to septic shock of urinary origin. Transthoracic right nephrectomy with diaphragmatic repair was performed. During the right thoracotomy, 500 mL of purulent fluid was observed in the thoracic cavity and so washout with physiologic solution was carried out. Multiple adhesions to the ectopic kidney/pleura were found and decorticated. An ectopic hydronephrotic sac was identified and dissected up to the renal hilum. The renal artery, renal vein, and ureter were ligated and cut and the ectopic kidney was extracted. Diaphragmatic repair was then performed with Dualmesh® and an abdominal cavity drain and intrapleural catheter were placed. The patient’s postoperative progression was satisfactory.
CONCLUSIONS: Cases of ectopic kidney may or may not require surgical treatment, depending on their symptomatology. Neither autopsy series nor clinical reports suggest that a thoracic kidney causes serious urinary or pulmonary complications.
KEYWORDS: Congenital diaphragmatic hernia; Renal ectopia; Transthoracic repair.
Axel Fabián Mora Ramírez
Facebook: Axel F. Mora Ramírez