RESUMO
O angiomiolipoma renal é um tumor benigno e incomum, que cursa com complicações variadas de modo agudo e crônico. Uma de suas manifestações mais dramáticas é a ruptura tumoral, que pode cursar com choque hemorrágico grave. Este relato de caso descreve um episódio de sangramento de grande monta de angiomiolipoma renal, previamente desconhecido, devido à um trauma contuso de baixa energia, que foi manejado com sucesso de modo conservador, utilizando protocolo análogo ao do tratamento não cirúrgico de lesões traumáticas de orgãos intra-abdominais, em um hospital de trauma de referência no Brasil
The renal angiomyolipoma is a benign and rare tumor, that may evolve with different types of acute and chronic complications. One of its most dramatic manifestations is the tumoral rupture, that may cause grave hemorrhagic shock. This case report describes an episode of large amount bleeding of an previously unknown renal angiomyolipoma, due to a low energy blunt trauma, that was successfully managed in a conservative way, using a protocol analogous to the one of non operative management of traumatic lesions of intra abdominal organs, in a reference trauma center in Brasil
RESUMO
PURPOSE: We evaluated our experience with laparoscopic donor nephrectomy in patients with multiple renal arteries, comparing operative outcomes and early graft function with patients with a single renal artery. MATERIALS AND METHODS: From January 2003 to February 2009, 130 patients underwent laparoscopic donor nephrectomy at our institution, 108 (83%) with a single renal artery and 22 (17%) with multiple arteries. Donor and recipient outcomes for single artery and multiple arteries allografts were compared. RESULTS: The LDN operative time was similar between the single artery and multiple arteries groups (162 vs 163 min, respectively, p = 0.87). Allografts with multiple arteries had significantly longer warm ischemia time (3.9 vs 4.9 min, p = 0.05) and cold ischemia time (72 vs 94 min, p < 0.001) than those with single artery. The conversion rate was similar between single and multiple arteries groups (6% vs 4.5%, respectively, p = 0.7). Multiple arteries grafts had a non statistically significant higher rate of poor graft function when compared to single artery grafts (23% vs 12%, respectively, p = 0.18). Five patients in the single artery group (4.6%) and one patient in the multiple arteries group (4.5%) needed dialysis during the first postoperative week. Overall, recipient complication rates were similar between single and multiple arteries groups (12.9% vs 18.1%, respectively, p = 0.51). CONCLUSION: Laparoscopic donor nephrectomy with multiple arteries was associated with a non statistically significant higher rate of poor early graft function. The procedure appears to be safe in patients with multiple arteries, with similar complications rates. Multiple arteries should not be a contraindication for laparoscopic donor nephrectomy.