Manishaben faced kidney failure at a young age. She had undergone kidney transplant four years ago. The operation was performed using robotic laparoscopy at India’s renowned IKD Hospital (Civil Hospital, Ahmedabad).
For four years, Manishaben lived a normal life and enjoyed her days. Five months ago, she started experiencing abdominal pain and visited United Green Hospital. Dr. Siddharth Jain, a kidney specialist, examined her, but the sonography showed normal kidneys and no issues were found. He suggested Manishaben to come for a check-up at 10:30 PM.
They were very anxious.
Me: What happened, Manishaben?
Patient: The pain has increased a lot, I’ve vomited, and I’ve had diarrhea two or three times. After having food outside two days ago, everything went wrong.
I called Dr. Siddharth Jain and informed him. “Two days after eating outside, all this happened, and now her condition is worsening.”
He asked for a urine test to be done immediately.
Me: The report shows “fluid creatinine.”
Dr. Siddharth: How is it possible? Manishaben hasn’t faced any issues even after four years of the transplant…
Me: Yes, I feel this might be the first case in India after a kidney transplant! But this is just a theoretical possibility. If it’s true, then we need to act quickly!
Diagnosis: “Urinary Ascites” – the urine flows from the kidney to the bladder through a ureter. For some reason, there’s a leak in Manishaben’s ureter, causing urine to accumulate in her abdomen.
Treatment: Her condition worsened until evening, and dialysis was necessary. A ureteric stent was inserted, but there were complications. Therefore, it was decided to shift her to another hospital (IKD, Civil, Ahmedabad). The transplant surgeon suggested putting a nephrostomy tube to divert urine outside the body (PCN). Until now, Manishaben is living with the tube attached.
Understanding of the Case:
- Leakage from the kidney into the bladder through the ureter is highly unusual. If this happens, even after the operation, within the first four to five days or, at most, a month, it might get detected.
- Such leaks are extremely rare and if they occur, they are usually visible within the first four to five days or, at most, within a month after the operation.
- If it happens after four years, it’s the first case in India!
- If we don’t diagnose it correctly, Manishaben won’t survive!
Thank you, Gayatri, for having the wisdom to diagnose this incredibly rare condition. 🙏🏻🙏🏻