Minimally invasive management of massive giant hydronephrosis in tertiary care centre Northern Sri Lanka: A case report

INTRODUCTION & IMPORTANCE: Giant hydronephrosis (GH) is defined as a kidney containing greater than 1000 ml of urine in its collecting system. It is a rarely presented condition in an adult. Common aetiology for GH is due to congenital ureteropelvic junction obstruction. We present a case of a late presentation of GH was being managed by a minimally invasive laparoscopic technique. CASE PRESENTATION: A 63-year-old Sri Lankan male presented with worsening of generalized abdominal swelling with vague abdominal symptoms for a six-month duration, found to have a GH of the left kidney on USS. The Contrast-enhanced computerized tomography (CECT) scan confirmed the diagnosis with 12l of fluid and possible ureteropelvic junction obstruction (UPJO). CT did not show any excretion of the left kidney. Hydronephrosis was drained one day before the surgery by a percutaneous nephrostomy tube. Laparoscopic transperitoneal nephrectomy was performed. The patient had a smooth and fast recovery. DISCUSSION: A neglected congenital UPJO can present with GH in adults. It causes vague abdominal symptoms like abdominal distension, dyspepsia, and fatigue. CECT will give the diagnosis and identify the aetiology of GH. Non-functional GH kidneys can be treated with nephrectomy by open or laparoscopic surgical technique. Laparoscopic nephrectomy shoes less blood loss during surgery, less postoperative pain and early recovery after surgery. However, in GH, surgeons need the experience to overcome the challenges like adhesions and working in a small space. CONCLUSIONS: The percutaneous nephrostomy decompression followed by laparoscopic transperitoneal nephrectomy is feasible for a massive GH.