Abstract: PO0326
Runaway Kidneys: First Case of Bilateral Herniated Kidneys in a Ventral Hernia
Session Information
- AKI: Clinical Case Reports
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 103 AKI: Mechanisms
Authors
- Jawed, Areeba, Wayne State University School of Medicine, Detroit, Michigan, United States
- Suleiman, Samah Saad Mohamed Ahmed, Wayne State University School of Medicine, Detroit, Michigan, United States
Introduction
Kidney herniation is extremely rare and typically seen in the setting of congenital defects. A handful of case reports have described traumatic thoracic herniation, postoperative renal transplant herniation and one report of postoperative incisional herniation. In this case report, we discuss the first case of bilateral kidney herniation into a ventral abdominal wall hernia.
Case Description
58-year-old male with a significant history of CKD stage IIIb, hypertension, large abdominal wall hernia, hypothyroidism presented to the Emergency Department with complains of abdominal pain and diarrhea. Vital signs were unremarkable and physical exam was pertinent for morbid obesity (BMI 0kg/m2) and a non-reducible ventral hernia. Labs revealed serum creatinine of 4.77 mg/dL with a prior baseline of 1.9-1.8 mg/dL. CT scan without contrast showed a massive ventral hernia containing pancreas, bilateral kidneys and loops of bowel forming pannus overlying the right anterior pelvic wall. Persistent mild hydronephrosis without a definitive obstructive mass, obstruction might be caused by tethering of the proximal ureter to this large ventral hernia. No improvement in renal function was noted despite fluid resuscitation and Foley catheter placement. Urology was consulted and patient was taken for cystoscopy with bilateral retrograde pyelograms and left diverting single-J ureteral stent insertion. His renal function improved remarkably following relief of obstruction and serum creatinine down trended to 2.87mg/dL at discharge. Patient was scheduled to follow up with nephrology and urology at discharge
Discussion
Kidney herniation is very uncommon and usually, only mobile structures, such as the small intestine and omentum are seen in ventral hernias. We postulate that mechanical forces related to obesity and prior surgeries played a role in the herniation of both kidneys which are normally firmly anchored in the retroperitoneum.