Renal Brucelloma in a Herniated Kidney

ABSTRACT www.urotodayinternationaljournal.comVolume 3 - February 2010 Renal Brucelloma in a Herniated Kidney INTRODUCTION Brucella is a common zoonotic infection worldwide. It can target many organs. However, the genitourinary system is infrequently involved, with a renal abscess being an even more uncommon complication [1]. The patient in this case report presented with flank pain and was diagnosed with a massively dilated right kidney with herniation through the femoral canal into the thigh. The diagnostic procedures and surgical approach will be discussed. CASE REPORT A 41-year-old Hispanic male presented with a 2-month history of right upper quadrant abdominal pain. Review of systems revealed chronic urinary frequency and urgency, fevers, night sweats, malaise, and back pain. Although he denied contact with livestock, he regularly consumed unpasteurized Mexican dairy products. On physical examinatin, he was found to have a right-sided mass spanning from the upper abdomen to the superomedial aspect of his thigh.Computed tomography (Figure 1a) revealed a massively hydronephrotic right kidney with parenchymal thinning, resulting in elevation of his liver into the chest and displacing his heart. The inferior aspect of the kidney was found to be herniating through the femoral canal into the thigh. Multiple stones were seen in the collecting system within the thigh (Figure 1b). There was moderate hydronephrosis and hydroureter of the contralateral kidney, but the renal parenchyma was considered to be normal on imaging. He was taken to the operating room and underwent a right nephrectomy via a thoracoabdominal incision. An inguinal incision was required to mobilize the inferior-most aspect of the kidney. Following removal of the kidney, the femoral hernia was repaired. Culture of the copious purulent material expressed during the operation grew