Acute Kidney Injury Following Conversion From Laparoscopic to Open Cholecystectomy

Abstract

Pneumoperitoneum during laparoscopic surgery is a complex physiologic event associated with neuroendocrine, respiratory, cardiovascular and renal disturbances as well as compromised organ blood flow. Impaired renal perfusion from pneumoperitoneum is attributed to intra-abdominal hypertension. Several mechanisms contribute to acute kidney injury (AKI) in such patients, including renal vein compression with impairment of the venous drainage. Renal artery vasoconstriction induced by the neuro-hormonal systems worsens outcomes. The final result is progressive reduction in both glomerular perfusion and urine output. We present a case of 58-year-old man who underwent open cholecystectomy following a failed laparoscopic cholecystectomy attempt. Postoperatively, he developed AKI. This was attributed to pneumoperitoneum, an essential part of the laparoscopic procedure. This case illustrates that even when there are no obvious risk factors for postoperative complications, a high index of suspicion should be maintained for early recognition and treatment of complications from this surgery.




J Med Cases. 2016;7(6):220-222
doi: http://dx.doi.org/10.14740/jmc2483w