Iatrogenic Injury of the Retroaortic Left Renal Vein during the Lymphadenectomy of the Aorta: Report of a Case

Abstract

The normal anatomic course of the left renal vein from the kidney to inferior vena cava is usually preaortic. It is called retroaortic left renal vein (RLRV) when located between the aorta and vertebra. The reported frequency of RLRV is approximately 2%. Only a small minority of RLRVs causes symptoms. However, this variation is of importance because of its implications in renal surgery, vascular surgery and so on. We herein report a case of a RLRV injured during the lymphadenectomy of the aorta. A 61-year-old female underwent hysterectomy and lymphadenectomy of the aorta for the purpose of curative operation of the left ovarian mucinous carcinoma in October 2016. Accidentally, the RLRV was injured, and the support of vascular surgeon was requested. Temporally tourniquet of the left renal artery was necessary to control the bleeding. The left renal vein was extremely damaged and ligation was needed. Fortunately, the patient had uneventful recoveries and she was discharged on the 23rd postoperative day without renal complications. The function of the left kidney is kept because of the collateral veins. Venous variant as reported herein should be kept in mind when interpreting imaging of the posterior abdominal wall or performing surgery or other invasive procedures near the RLRV. This anomaly can be identified in routine abdominal CT examinations with a careful inspection.