About this Journal Submit a Manuscript Table of Contents
Case Reports in Transplantation
Volume 2014 (2014), Article ID 561506, 4 pages
http://dx.doi.org/10.1155/2014/561506
Case Report

Torsion of the Retroperitoneal Kidney: Uncommon or Underreported?

1Medstar Georgetown Transplant Institute, Georgetown University Hospital, 3800 Reservoir Road, NW, Main Hospital Building, Second Floor, Washington, DC 20007, USA
2Georgetown University School of Medicine, Medical Dental Building, 3900 Reservoir Road, NW, Washington, DC 20057, USA

Received 29 September 2013; Accepted 28 October 2013; Published 16 January 2014

Academic Editors: D. Conti and M. Klinger

Copyright © 2014 Michael Sosin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Vascular torsion in a renal allograft after placement in the retroperitoneum is rare and has only been reported twice in the literature. It is an extrinsically mediated process that occurs at the vascular pedicle resulting in graft compromise and potential loss. Rapid diagnosis and immediate surgical intervention may salvage allograft function. Herein, we present a unique case of a 42-year-old male that developed renal allograft torsion following a second kidney transplant placed in the retroperitoneum. Immediate detorsion did not resolve allograft dysfunction, and a biopsy revealed acute cellular mediated rejection. After antithymocyte globulin treatment, allograft function was salvaged. A review of the current literature shows that the incidence, morbidity, and long term allograft function of intraperitoneal and extraperitoneal torsion are different. As such, torsion of the retroperitoneal kidney demonstrates encouraging allograft salvage rates. Only the third case reported to date, this serves as a contribution to the growing body of literature in retroperitoneal renal torsion and reviews the risks, medication considerations, diagnostic tests, and treatment modalities in a unique disease process.