Packing of Renal Fossa: Useful Technique for Intractable Bleeding after Open Pyelolithotomy Surgery
A 65 year old man was taken up for open pyelolithotomy for large staghorn calculus by a urologist in a Medical college. I was called for help as the patient started having intractable bleeding after the removal of staghorn calculus. The urologist started contemplating nephrectomy as a desperate measure. I suggested to him to pack the renal fossa with roller gauzes as neither pre operative IVP nor B negative blood was not available in the blood bank. The renal fossa was packed with three long roller gauze packs, as bleeding continued after approximation of pyelotomy incision with three interrupted 3-0 vicryl sutures. One roll of gauze was placed over the pyelotomy bleeding or oozing site, second roll of gauze was placed on the medial side of the kidney and third roll of gauze was placed on the lateral side of kidney to fill the renal fossa. All these rolls were tied together and brought out from the posterior end of the main wound. The main wound was closed in layers for better tamponade effect. One 30F tube drain was also kept which was brought out from a separate stab incision. The patient was shifted to the high dependency unit (HDU) for post operative monitoring. All three packs were removed under sedation in the HDU after 24 hours. The patient had uneventful post operative course and was discharged on 10 th post operative day after suture removal. The renal functions were found to be normal at the time of discharge.