UOTW #32 Answer

Diagnosis: large post-op hematoma and hemorrhage

In the OR, they removed a large amount of clot and old hemorrhage. There was s a small laceration seen at the posterior portion of the transplant renal parenchyma. There was some communication of old blood from the intra-abdominal portion into the retroperitoneum via the ovarian ligaments.

  • The most common surgical complications involving renal transplants are renal vein thrombosis, renal artery thrombosis, ureter obstruction, urine leak and a wound infection.
  • Bleeding is uncommon after a surgery, and if it does occur, is usually due to unligated vessels in the graft hilum or from small severed retroperitoneal vessels of the recipient.1 In this patient, it was from a laceration to the donor kidney.
  • Risk factors for post-surgical bleeding include recipient obesity, antiplatelet agents, and anticoagulation.1
  • Abdominal ultrasound has been found to reliably detect between 250-620 mL of intraperitoneal fluid.2
  1. Humar A, Matas AJ. Surgical complications after kidney transplantation. Semin Dial. 2005;18(6):505-10.
  2. Rose J. Ultrasound in Abdominal Trauma. Emerg Med Clin N Am 2004;22:581-99

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