Page phenomenon in a transplanted kidney: is it salvageable?

Abstract

A male in his late 70s with a history of an uncomplicated kidney transplantation 20 years prior was brought to the Emergency Department after experiencing blunt abdominal trauma following a motor vehicle collision. Imaging revealed a large perinephric haematoma, a retroperitoneal haematoma and multiple fractures. He was admitted to the intensive care unit where a renal haematoma was found to be expanding with ultrasonography (US) and developed renal dysfunction including anuria and hyperkalemia. His creatinine rose to twice his baseline and Doppler US showed elevated resistive indices, confirming extrinsic compression and causing a Page phenomenon. An open surgical exploration through the upper aspect of his Gibson incisional scar was performed followed by evacuation of the haematoma. An intraoperative US was done demonstrating good flow in the renal vessels. His postoperative course was uncomplicated and was discharged home with renal function back to baseline. On follow-up, he continued to have a good renal function.

Keywords: Dialysis; Renal medicine; Renal transplantation; Transplantation; Ultrasonography.

Figure 1

CT image showing perinephric subcapsular haematoma measuring 9.8 cm in diameter located over the right iliac fossa with signs of active contrast extravasation, consistent with active haemorrhage.

Figure 2

CT image highlighting the retroperitoneal haematoma with foci of contrast extravasation suggestive of active haemorrhage, which could be either venous or arterial.

Figure 3

Coronal CT image showing the large 9.8 cm subcapsular haematoma over the transplanted renal allograft.

Figure 4

US at the time of admission (A), followed by a few hours prior to surgery (B) showing loss of forward diastolic flow and US postoperatively (C) with downtrending resistive indices.