FACULTY:
Dr. Zeeshan Rahman - Consultant Urology

PRESENTING / CHIEF COMPLAINTS:
The patient had an episode of right flank pain x 1 month back
NCCT KUB showed staghorn calculus with no renal parenchyma. DTPA done showed 10 % function. The patient was admitted for further treatment and surgical management.

CLINICAL FINDINGS:
* Stuck right kidney with IVC plastered onto the kidney and a frozen hilum.

DIAGNOSIS:
Xanthogranulomatous pyelonephritis with non-functioning kidney secondary to staghorn calculus.

TREATMENT PERFORMED:
Right laparoscopic nephrectomy under General Anesthesia.

HIGHLIGHTS OF THE CASE:
* Stuck kidney with IVC dangerously plastered onto the kidney
* Frozen hilum
* Advanced laparoscopy performed successfully.
* Avoided conversion to open despite renal artery injury.
* Stable recovery after treatment.

SPECIAL NOTE:
This case highlights, Dr. Zeeshan Rahman’s expertise in  successfully completing a laparoscopic nephrectomy while safely manoeuvring around the IVC which was plastered onto the right kidney.
The hilum was frozen with minimal space for dissection.
The renal artery was injured iatrogenically while dissecting which was handled skilfully with minimal blood loss or conversion to open.
After surgery, the patient recovered well and was discharged on the 3rd postoperative day.