Case Study: Why 55-Yr-Old Experiencing Abdominal Pain, Blood In Urine Needed Emergency Kidney Surgery

The case was a tricky one, a surgery was inevitable. The patient had lost a lot of blood. He was also in severe pain. Then, the doctors found that his normal abdominal anatomy was lost!

The patient had been on dialysis for several years, due to autosomal dominant polycystic kidney disease, which is a genetic disorder characterised by cyst formation in the kidneys. (Photo: Freepik/representational)

A 55-year-old man had to undergo an intricate and complicated surgery recently, as he had been suffering from autosomal dominant polycystic kidney disease (ADPKD) which, according to the UK's National Health Service (NHS), is a genetic fault that can 'disrupt' the normal development of some of the kidney cells, leading to the growth of cysts. Basically, there are small fluid-filled sacs that develop inside the kidneys and cause a lot of pain and distress. Although people affected by ADPKD are usually born with the condition, it does not always cause 'noticeable problems'. Problems arise when the cysts grow large and begin to affect the kidneys' functions. In this patient's case, he was treated by a surgical team led by Dr Vikas Bhise, consultant urologist at Medicover Hospital, Navi Mumbai. The man had arrived at the emergency department in a critical condition, complaining of severe abdominal pain and blood in the urine. He underwent a nephrectomy procedure to remove a massive 35 cm kidney mass. Later, he was discharged from the hospital; he has now comfortably resumed his daily routine and is leading a healthier life. Read on to know more about the case.

The patient had been on dialysis for several years, due to autosomal dominant polycystic kidney disease (ADPKD) which, as mentioned earlier, is a genetic disorder characterised by cyst formation in the kidneys. He had sought treatment for the same from Dr Amit Nagrik, a senior nephrologist at Medicover Hospital, and was even ready for a kidney transplant. Every day was a challenge for the patient, who had to heavily depend on his family for basic support. He felt excruciating pain every day, and was shrouded in uncertainty and the emotional burden of watching his loved ones shoulder his care.

In a statement shared by the hospital, Dr Bhise said that upon arrival, the patient had lost a lot of blood from urine and was in 'hypotension'. "He had a known case of ADPKD for which he was following up. In ADPKD, the kidney is replaced by a fluid-filled cyst, and it's a rare genetic disorder and rarer to present with such a huge mass," the doctor explained. He added that with time, the man's abdomen had become 'severely distended'. "When the bleeding started, he knew his condition had become life-threatening. This was a sporadic and challenging case due to the size and complexity of the kidney mass, which was 35 cm. The kidney was not only enlarged but the whole abdomen was tensed, making surgical removal meticulous and demanding. We opted for an open approach because cysts occupied the entire abdomen."

According to the doctor, what made the case extra unique and challenging was that the normal anatomy of the abdomen was lost. "Thanks to a dedicated surgical team and careful planning, the surgery was completed in two hours with minimal blood loss. The patient required no postoperative transfusion, either," the expert stated, adding that had he not received treatment at the right time, the patient could have suffered from complications of shock and severe blood loss.

"Seeing him recover so well is immensely gratifying. [He was] discharged just three days after surgery and mobilised the very next day. He is now on the path to regaining a better quality of life," Dr Bhise concluded.