Total laparoscopic hysterectomy in a patient with an ectopic kidney: A case report

Ryosuke Tamura, Reona Kakinuma, Takeo Hirakawa, Makito Mizunuma, M Sato
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2021 · vol. 37(1) , pp. 97–101 · doi:10.5180/jsgoe.37.1_97 · W3167754376
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This case report details a successful total laparoscopic hysterectomy in a patient with a right ectopic kidney, despite a minor bladder injury during the procedure.

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This case report describes total laparoscopic hysterectomy in a 42-year-old gravida 0 para 0 woman with uterine adenomyosis, persistent genital bleeding, and low abdominal pain, who also had a right ectopic kidney. Preoperative imaging with MRI and drip infusion pyelography identified uterine adenomyosis and a short right ureter without other urinary tract malformations, and the surgery was performed with a four-port TLH approach. During the procedure, the muscular layer of the bladder was accidentally injured but repaired with single-layer closure, with estimated blood loss of 50 mL, an operation time of 111 minutes, no postoperative complications, and discharge on postoperative day 7. The authors explicitly note that detailed preoperative evaluation is warranted to confirm urinary tract location prior to TLH in patients with an ectopic kidney. This paper is centrally about endometriosis and/or adenomyosis—specifically adenomyosis—because it reports TLH for uterine adenomyosis in a patient with an ectopic kidney.

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Abstract

An ectopic kidney is a congenital anomaly characterized by an abnormal location of the kidney. In this report, we describe total laparoscopic hysterectomy (TLH) in a patient with an ectopic kidney. A 42-year-old gravida 0 para 0 woman was referred to our hospital for management of uterine adenomyosis with persistent genital bleeding and low abdominal pain. Magnetic resonance imaging revealed uterine adenomyosis and a right ectopic kidney. Drip infusion pyelography revealed a short right ureter without any other urinary tract malformations. She underwent four-port TLH. A 12-mm navel port was placed using the open method, and a 5-mm port was placed on the right side of the lower abdomen with the help of laparoscopic forceps. The muscular layer of the bladder was accidentally injured but was successfully repaired using single-layer closure, and routine TLH was performed. The estimated blood loss was 50 mL, and the operation time was 111 min. A urinary catheter was placed for one week. No postoperative complications were observed, and the patient was discharged on the 7th postoperative day.
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症例報告 変位腎を有する子宮腺筋症症例に対し腹腔鏡下子宮全摘術を施行し得た1例 2021 年 37 巻 1 号 p. 97-101 詳細 抄録 An ectopic kidney is a congenital anomaly characterized by an abnormal location of the kidney. In this report, we describe total laparoscopic hysterectomy (TLH) in a patient with an ectopic kidney. A 42-year-old gravida 0 para 0 woman was referred to our hospital for management of uterine adenomyosis with persistent genital bleeding and low abdominal pain. Magnetic resonance imaging revealed uterine adenomyosis and a right ectopic kidney. Drip infusion pyelography revealed a short right ureter without any other urinary tract malformations. She underwent four-port TLH. A 12-mm navel port was placed using the open method, and a 5-mm port was placed on the right side of the lower abdomen with the help of laparoscopic forceps. The muscular layer of the bladder was accidentally injured but was successfully repaired using single-layer closure, and routine TLH was performed. The estimated blood loss was 50 mL, and the operation time was 111 min. A urinary catheter was placed for one week. No postoperative complications were observed, and the patient was discharged on the 7th postoperative day. Detailed preoperative evaluation is warranted to confirm the location of the urinary tract prior to TLH in patients with an ectopic kidney. © 2021 日本産科婦人科内視鏡学会

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