Close encounters of the peritoneal kind: case series and literature review of uroperitoneum. Lessons for the clinical ne
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LESSONS FOR THE CLINICAL NEPHROLOGIST
Close encounters of the peritoneal kind: case series and literature review of uroperitoneum. Lessons for the clinical nephrologist Sam Kant1 · Steven Menez1 · Mohamad Hanouneh1,2 · Derek M. Fine1 Received: 6 August 2020 / Accepted: 14 September 2020 © Italian Society of Nephrology 2020
Keywords Uroperitoneum · Acute kidney injury · Ascites · Creatinine
Case 1 A 74-year-old male with a history of ischemic heart disease, presented with increasing abdominal distension 10 days following a robotic-assisted radical prostatectomy. The patient’s symptoms had progressively worsened since removal of his urinary catheter 4 days post-surgery, with reduction in urine output. At the time of nephrology consultation for AKI, he was noted to have gross ascites and underwent subsequent paracentesis. Laboratory data at the time of nephrology consultation are listed in Table 1. A computed tomography (CT) of the abdomen/pelvis without contrast revealed abdominopelvic ascites contiguous with focal fluid at the surgical bed adjacent to the vesicoureteral anastomosis (sFigure 11), with CT cystography confirming the diagnosis. Urine output and renal function improved following indwelling urinary catheter placement.
Case 2 A 32-year-old woman presented at 40 weeks gestation for a cesarean section. On postpartum day 4, she was noted to have progressively increasing abdominal distension with the presence of ascites.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40620-020-00867-1) contains supplementary material, which is available to authorized users. * Sam Kant [email protected] 1
Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument St, Suite 416, Baltimore, MD 21287, USA
Nephrology Center of Maryland, Baltimore, MD, USA
2
A nephrology consultation was requested to evaluate her for AKI, with serum creatinine of 9.7 mg/dL a subsequent diagnostic paracentesis was carried out An abdomen/pelvis CT with contrast demonstrated a large volume of ascites with extravasation of contrast from the bladder, consistent with bladder injury (sFigure 2). Insertion of a urinary catheter resulted in rapid correction of renal function, and a subsequent cystogram showed resolution of the urine leak (sFigure 3).
Case 3 A 37-year-old male with a history of alcohol abuse presented to the emergency department with abdominal pain and nausea for 1 week post mechanical fall. A nephrology consultation was requested due to laboratory findings on admission that are listed in Table 1. An abdomen/pelvis CT without contrast showed diffuse ascites (with no evidence of cirrhosis), with subsequent large-volume paracentesis. However, there was a massive re-accumulation of ascitic fluid within 8 h of the procedure. Due to worsening of renal indices and refractory hyperkalemia, dialysis was initiated with an initial presumed diagnosis of hepatorenal syndrome. Due to unexplained ascites, high peritoneal fluid creatinine
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