Horseshoe kidney injury during laparoscopic inguinal herniorrhaphy

A 23-year-old man was admitted to our department following laparoscopic right-side inguinal herniorrhaphy at a community-based hospital. Gross hematuria led to the diagnosis of renal pelvis injury that was first suspected on sonography. A computerized tomography (CT) scan revealed perforation of a horseshoe kidney with blood clots in the renal pelvis. Retrograde pyelography showed extravasation into perirenal tissue. The renal pelvis injury was managed conservatively by drainage of the upper urinary tract by transurethral placement of a mono-J stent. Serial sonography tests and a repeated retrograde pyelography revealed complete resolution of blood clots and perirenal urinoma. The clinical course was uneventful, with the double-J stent left in place for 4 weeks. To our knowledge, this is the first case report of a renal pelvis perforation in a horseshoe kidney during laparoscopic inguinal herniorrhaphy. In the present case, preoperative abdominal sonography would have been helpful to demonstrate the anatomical aberration. In general, but even more so in the case of anatomic abnormalities, the execution of a mini-laparotomy is recommended to allow a safe insertion of the optical trocar. This precaution would ensure that such injuries are avoided.