Embolization of insufficiently ligated renal artery after open nephrectomy with absolute ethanol injection

Abstract

A 54-year-old woman was admitted to hospital for hypotension and anemia which was due to intermittent hemorrhage from a lumbar drain. She had undergone open nephrectomy ten days earlier in another hospital for the right dysfunctional kidney with staghorn calculi. Ultrasound in our hospital showed a right retroperitoneal hematoma. Surgical exploration was performed twice whereby the hematoma was partially eliminated; however, the point of bleeding was not identified. Repeated attacks of bleeding from the drain accompanied by acute pain made the hypotension with tachycardia even worse, which led to a life-threatening hemorrhagic shock. Extravasation from the insufficiently ligated right renal artery was then shown on computed tomography aortography. After selective catheterization of this arterial stump with a mixture of alcohol and contrast media, complete occlusion of the remaining part of the resected renal artery was achieved. Application of absolute alcohol, though risky, proved to be a quick and efficient alternative method of occlusion of the bleeding renal arterial stump.