nephrology image
http://www.kidney-international.org & 2014 International Society of Nephrology Kidney International (2014) 86, 1275; doi:10.1038/ki.2014.132
Why remove, when you can preservey Smart Zeidan1, Rezkalla Akkary1, Ramy Ghabril2, Nabil Diab1 and Pauline Abou-Jaoude3 1
Department of Pediatric Surgery and Urology, Saint George University Hospital, University of Balamand, Beirut, Lebanon; 2Department of Clinical Pediatrics and Nephrology, Saint George University Hospital, University of Balamand, Beirut, Lebanon and 3Department of Clinical Pediatrics and Nephrology, Medical University Center–Rizk Hospital, Beirut, Lebanon Correspondence: Smart Zeidan, Department of Pediatric Surgery and Urology, Saint George University Hospital, Achrafieh, P.O. Box 166378, Beirut 1100 2807, Lebanon. E-mail: [email protected]
Kt
Ft
LO Ov
Figure 1 | Entrapment of bilateral ovarian fimbria in the peritoneal dialysis catheter.
Figure 2 | Left oophoropexy by a nonabsorbable stitch to psoas muscle. FT, fallopian tube; Kt, peritoneal dialysis catheter; LO, left oophoropexy; Ov, ovary.
A 4-year-old girl presented for management of malfunctioning peritoneal dialysis catheter (PDC). The patient had an end-stage renal failure due to reflux nephropathy on left solitary kidney. The peritoneal catheter ‘Tenckhoff type’ was inserted by laparotomy 2 months ago. On physical examination at presentation, the abdomen was soft, not distended, and with no erythema at catheter insertion site. A salvage laparoscopy was performed. Bilateral ovarian fimbria were found entrapped in the PDC (Figure 1). A bilateral oophoropexy by fixing the uretero-ovarian ligament to the
psoas muscle by a nonabsorbable stitch (Figure 2) and partial omentectomy were performed. Six months postoperatively, the patient had a well-functioning catheter. Although obstruction of a PDC by an ovarian fimbria has been reported, fimbrectomy to prevent obstruction recurrence was proposed as the treatment of choice in the literature. This report highlights the efficiency of a laparoscopic bilateral oophoropexy to avoid an entrapment of ovarian fimbria in the PDC and to preserve the future fertility of an especially young girl.
Kidney International (2014) 86, 1275
1275
http://www.kidney-international.org & 2014 International Society of Nephrology Kidney International (2014) 86, 1275; doi:10.1038/ki.2014.132
Why remove, when you can preservey Smart Zeidan1, Rezkalla Akkary1, Ramy Ghabril2, Nabil Diab1 and Pauline Abou-Jaoude3 1
Department of Pediatric Surgery and Urology, Saint George University Hospital, University of Balamand, Beirut, Lebanon; 2Department of Clinical Pediatrics and Nephrology, Saint George University Hospital, University of Balamand, Beirut, Lebanon and 3Department of Clinical Pediatrics and Nephrology, Medical University Center–Rizk Hospital, Beirut, Lebanon Correspondence: Smart Zeidan, Department of Pediatric Surgery and Urology, Saint George University Hospital, Achrafieh, P.O. Box 166378, Beirut 1100 2807, Lebanon. E-mail: [email protected]
Kt
Ft
LO Ov
Figure 1 | Entrapment of bilateral ovarian fimbria in the peritoneal dialysis catheter.
Figure 2 | Left oophoropexy by a nonabsorbable stitch to psoas muscle. FT, fallopian tube; Kt, peritoneal dialysis catheter; LO, left oophoropexy; Ov, ovary.
A 4-year-old girl presented for management of malfunctioning peritoneal dialysis catheter (PDC). The patient had an end-stage renal failure due to reflux nephropathy on left solitary kidney. The peritoneal catheter ‘Tenckhoff type’ was inserted by laparotomy 2 months ago. On physical examination at presentation, the abdomen was soft, not distended, and with no erythema at catheter insertion site. A salvage laparoscopy was performed. Bilateral ovarian fimbria were found entrapped in the PDC (Figure 1). A bilateral oophoropexy by fixing the uretero-ovarian ligament to the
psoas muscle by a nonabsorbable stitch (Figure 2) and partial omentectomy were performed. Six months postoperatively, the patient had a well-functioning catheter. Although obstruction of a PDC by an ovarian fimbria has been reported, fimbrectomy to prevent obstruction recurrence was proposed as the treatment of choice in the literature. This report highlights the efficiency of a laparoscopic bilateral oophoropexy to avoid an entrapment of ovarian fimbria in the PDC and to preserve the future fertility of an especially young girl.
Kidney International (2014) 86, 1275
1275
