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CASE REPORT
Year : 2016  |  Volume : 43  |  Issue : 3  |  Page : 158-160

Intrarenal foreign body mimicking an ureteropelvic junction stone


1 Department of Urology, KLE Kidney Foundation, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, India
2 Department of Studies in Biotechnology and Microbiology, Karnatak University, Dharwad, Karnataka, India

Date of Web Publication14-Sep-2016

Correspondence Address:
Rajendra B Nerli
KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Nehru Nagar, Belagavi - 590 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-5009.190551

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  Abstract 

Prevention of retained/forgotten foreign bodies, including surgical sponges and gauzes is clearly better than the treatment of the complications, and strict safeguards can ensure prevention of such complications. We report on a very rare case of leftover piece of gauze within the renal pelvis of a child that mimicked a urinary stone.

Keywords: Foreign body, gauze piece, textiloma


How to cite this article:
Sharma V, Magdum PV, Nerli RB, Devaraju S, Ghagane SC. Intrarenal foreign body mimicking an ureteropelvic junction stone. J Sci Soc 2016;43:158-60

How to cite this URL:
Sharma V, Magdum PV, Nerli RB, Devaraju S, Ghagane SC. Intrarenal foreign body mimicking an ureteropelvic junction stone. J Sci Soc [serial online] 2016 [cited 2022 Dec 5];43:158-60. Available from: https://www.jscisociety.com/text.asp?2016/43/3/158/190551


  Introduction Top


Foreign bodies in the kidney are very rare entities and one of the most common routes through which kidneys may be reached is the gastrointestinal tract. Such foreign bodies are typically lacerating objects in food (such as fishbone, needles, pins, hair grips, toothpicks). [1] Surgical sponges or gauzes left after renal surgery are scarcely reported in medical literature and in an intrarenal location they are even rarer. [2],[3],[4] However, such retained textilomas are obviously underreported mainly because of medical and legal problems.

Presentation includes purulent cutaneous fistula, renal and perirenal pseudotumors, and renal calculus formation. [2],[3],[4],[5] Additionally, these foreign bodies can remain asymptomatic for years and a proper follow-up with radiological evaluation can assist in the proper diagnosis prior to the appearance of symptoms. [3],[5] We report a rare case of leftover piece of gauze in the renal pelvis.


  Case report Top


A 10-year-old male child presented with a history of pain, in the left loin, of a duration of over 2 years. The child was operated at the age of 2 years for suspected ureteropelvic junction obstruction (UPJ) at another institute. Abdominal ultrasonography revealed a left-sided hydronephrosis secondary to renal pelvic calculi. Contrast-enhanced computerized tomography (CT) examination confirmed the diagnosis of hydronephrosis with thinned out parenchyma with prompt uptake and excretion of the contrast. There was a hypodense object in the left renal pelvis suggestive of a matrix stone [Figure 1].
Figure 1: CT KUB showing left gross hydronephrosis with radiodense object in the left renal pelvis suggestive of a stone in UPJ

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Under general anesthesia, the child underwent percutaneous renal surgery. The stone-like lesion is shown in [Figure 2]. The soft lesion was gradually extracted with the manipulation of the forceps. The extracted material was a leftover piece of gauze [Figure 3]. Following removal of the piece of gauze, nephrostography was done that revealed a good flow of contrast down the UPJ. Double J (DJ) stent and a nephrostomy tube were placed. Nephrostomy tube was removed on the 2nd postoperative day. Postoperative period was uneventful and the child was discharged. DJ stent was removed after 4 weeks.
Figure 2: Visible textile strands on percutaneous nephrostomy

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Figure 3: Extracted gauze piece during surgery

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  Discussion Top


Retained or leftover surgical sponges, cotton, gauze pieces so-called textilomas, are rare complications after abdominal surgeries. The estimated incidence is approximately 1 per 1,000-1,500 surgical operations. [6] In a retroperitoneal location, these textilomas represent less than 17% of abdominal locations and reports of renal or perirenal textilomas are scarce. [5] It is difficult to make a preoperative diagnosis because they mimic tumors, abscesses, pseudocysts, or hematomas.

In our case, the diagnosis was not suspected preoperatively because the first surgery was performed in another institution without postoperative follow-up and the foreign body had no radiopaque markers. Several previous descriptions of CT and magnetic resonance imaging (MRI) appearances of a retained sponge have been reported. The retained sponge may have a whorl-like appearance on CT and MRI, with increased intensity in T2-weighted, compared to T1-weighted images. [3] However, CT and MRI cannot unequivocally distinguish a retained foreign body from other urologic diseases such as abscesses, tumors, and calculi. [5]

Prevention of such complications should be the priority rather than managing them. Compresses should be used one by one, mounted on forceps. Before closing the incision, the surgeon and the nurses should audit all the instruments and surgical sponges used. Small sponges should preferably be avoided during laparotomy and only sponges with radiopaque filaments should be used. A plain X-ray film, if possible, should be taken before finishing any operation so as to avoid these medicolegal embarrassments.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
van Ophoven A, deKernion JB. Clinical management of foreign bodies of the genitourinary tract. J Urol 2000;164:274-87.  Back to cited text no. 1
    
2.
Ballesteros Sampol JJ, Alameda Quitllet F, Pares Puntas ME. 3 rare cases of textiloma after renal surgery. Review of the literature. Arch Esp Urol 2002;55:25-9.  Back to cited text no. 2
    
3.
Ben Meir D, Lask D, Koren R, Livne PM. Intrarenal foreign bogy presenting as a solid tumor. Urology 2003;61:1035.  Back to cited text no. 3
    
4.
Bellin MF, Hornoy B, Richard F, Davy-Miallou C, Fadel Y, Zaim S, et al. Perirenal textiloma: MR and serial CT appearance. Eur Radiol 1998;8:57-9.  Back to cited text no. 4
    
5.
Coelho RF, Mitre AI, Srougi M. Intrarenal foreign body presenting as a renal calculus. Clinics (Sao Paulo) 2007;62:527-8.  Back to cited text no. 5
    
6.
Jason RS, Chisolm A, Lubetsky HW. Retained surgical sponge simulating a pancreatic mass. J Natl Med Assoc 1979;71:501-3.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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