Unusual presentation of duplex collecting system: a case report

Duplex collecting systems [also known as duplicated collecting systems] can be defined as renal units containing two pyelo-caliceal systems that are associated with a single ureter or double ureters. The two ureters empty separately into the bladder or fuse to form a single ureteral orifice. We came across a case in which the diagnosis was in dilemma until actual surgery when it was finally diagnosed as a case of duplex collecting system

Rhabdomyolysis and myogloginuric acute renal failure in the lithotomy/exaggerated lithotomy position of urogenital surgeries

To evaluate rhabdomyolysis and it's management in lithotomy and the exaggerated lithotomy positions during urogenital surgeries. Retrospective study. Institute of Post Graduate Medical Education and Research [IPGME and R], Kolkata, India. Patients undergoing urogenital surgeries [lithotomy and the exaggerated lithotomy positions]. All four cases of rhabdomyolysis which occurred after such positional urogenital surgeries were treated with conservative management for prolonged period with hemodialysis. One case which developed compartment syndrome underwent fasciotomy and also managed with conservative approach as other cases. Rhabdomylysis is now a rare complication in any open or laparoscopic surgery. But prolonged lithotomy or exaggerated lithotomy position surgeries have been shown to expose patients to the risk of rhabdomylysis and acute renal failure. In our institute patients undergoing urogenital surgeries in lithotomy and the exaggerated lithotomy positions only developed rhabdomyolysis and myogloginuric acute renal failure. All procedures were of prolonged duration [mean five hours and ten minutes]. Three patients developed rhabdomyolysis and acute renal failure without compartmental syndrome and one with compartmental syndrome. Rhabdomyolysis with the appearance of acute renal failure is discussed. Overall, our cases showed that rhabdomyolysis and acute renal failure can develop in such operative positions even in the absence of compartmental syndrome, and that duration of surgery is the most important risk factor for such complications. So we should be careful regarding duration of surgery in lithotomy procedure to prevent such morbid complications

Chylous leakage after donor nephrectomy: a rare complication and a nightmare for surgeons

To evaluate chylous drainage and its management in donor nephrectomy patients. Retrospective study. Institute of Post Graduate Medical Education and Research [IPGME and R], Kolkata, and Medica Superspeciality Hospital, Kolkata, Kolkata, India. Donor nephrectomy patients [open or laparoscopy procedure]. The first case of chylous drainage which occurred after open donor nephrectomy was treated with conservative management for a prolonged period after browsing through literature. Later three cases which occurred after laparoscopic donor nephrectomy, were also managed conservatively. Incidence and management of chylous ascites or drainage after open or laparoscopic donor nephrectomy. In our institute, only four donor nephrectomy patients developed chylous drainage. Three were laparoscopic surgeries using the transperitoneal approach whereas one case was done using open retroperitoneal approach. Chylous drainage and its management are discussed. Overall, our cases showed that chylous drainage can develop in laparoscopic transperitoneal procedures as well as in open retroperitoneal surgery, and that surgical dissection in the retroperitoneal area or the renal hilum is the most important risk factor for this complication. All our cases were well-treated only by conservative management and it has proven to be the main first line management for this condition