CASE 50: Parenchymal Injury in a Laparoscopically Procured Live Donor Kidney

Laparoscopically procured live donor kidney that showed a subcapsular fluid collection on the dorsal aspect of the kidney after flushing it with preservation fluid during the back-table preparation. It was decided to preserve the capsule intact since sometimes hemorrhage can be self-limiting. Note that there is minimal blood within the collection. Most of its content is clear fluid, representing preservation solution that likely extravasated into the subcapsular space via a parenchymal injury sustained at the time of removal of the organ from the body (via an incision too small to accommodate it).

After implantation and reperfusion, the collection expanded rapidly (white arrow).

The subcapsular hematoma continued to expand, and the renal capsule developed increasing tension. The capsule was incised with a cautery, and blood (green arrows) was released under pressure.

The capsule was further incised, and the hematoma started to evacuate spontaneously (arrow).

The hematoma was fully evacuated (arrow).

When the capsule was further opened to address the ongoing hemorrhage (arrow), a parenchymal tear was identified.

The site was repaired with resorbable 4-0 running sutures (arrows). The injury was most likely sustained when the organ was removed in a bag through an abdominal incision too small for its size.