Surgical Management of Retroperitoneal Cystic Lesion in a Solitary Kidney Patient — A Case by Dr. Manoj Dongare
How a Rare Adrenal Tumour Was Successfully Removed While Saving the Only Remaining Kidney in Pune
Imagine having only one kidney — and then developing a tumour right next to it. For a 64-year-old lady, this was a terrifying reality. What made her case even more complex was that the tumour turned out to be a rare variant of pheochromocytoma — a diagnosis that was only confirmed after surgery. This is the story of how Dr. Manoj Dongare successfully navigated one of the most challenging surgical scenarios in HPB and oncological surgery.
The Patient and Her Medical History
A 64-year-old female patient presented with pain in her left flank. Her medical history added significant complexity to the case:
She had undergone a right nephrectomy (removal of the right kidney) 10 years ago for pyonephrosis — a severe kidney infection
This meant she was now living with a solitary left kidney — her only functioning kidney
Any damage to this kidney during surgery would mean permanent kidney failure and lifelong dialysis
The patient was referred to Dr. Manoj Dongare at D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune and Cloverleaf Speciality Clinic, Wakad, Pune-PCMC — given the extreme complexity of the case.
Diagnosis — A Puzzling CT Scan Finding
A CT scan revealed a concerning finding:
A cystic lesion in the retroperitoneum — the space behind the abdominal organs
The lesion was abutting the tail of the pancreas
It was adherent to the left renal vein — the main vein draining the only remaining kidney
Two possible diagnoses were considered:
Cystic neoplasm of the pancreas
Adrenal tumour
The proximity of the tumour to the left renal vein made surgery extremely high risk — one wrong move could damage the kidney's blood supply irreversibly.
Pre-Operative Workup — Ruling Out a Functional Tumour
Before proceeding with surgery, Dr. Manoj Dongare ordered a critical pre-operative investigation:
Metanephrine level tests — to check whether the tumour was a functional pheochromocytoma (a type of adrenal tumour that produces hormones causing dangerous spikes in blood pressure during surgery)
Result — Metanephrine levels were normal — ruling out a functional tumour and making surgery safer to proceed
This careful pre-operative planning is what distinguishes expert surgical care from routine management.
The Surgery — Precision at Its Best
The surgery performed by Dr. Manoj Dongare was technically one of the most demanding procedures in surgical oncology.
Step-by-step surgical approach:
Release of adhesions — Scar tissue from the previous right nephrectomy surgery was carefully dissected and released
Identification of the cystic lesion — The tumour was found arising from the adrenal gland and firmly adherent to the left renal vein
Meticulous dissection off the renal vein — The tumour was carefully separated from the renal vein without damaging it
Tying off large branches — All large blood vessel branches supplying the tumour from the renal vessels were carefully tied off
Complete tumour removal — The cystic lesion was fully excised
Kidney preservation — The solitary left kidney was completely saved with its blood supply intact
The surgical challenge here was immense — operating in a field with previous adhesions, next to the only functioning kidney, with a tumour stuck to the main renal vein.
Post-Operative Recovery and Final Diagnosis
The patient's recovery was smooth and uneventful:
✔️ No complications after surgery
✔️ Kidney function preserved — no dialysis required
✔️ Discharged in stable and good condition
Histopathology Report (HPR) revealed: The lesion was confirmed as an oncocytic variant of pheochromocytoma — a rare and unusual type of adrenal tumour that had presented as a cystic lesion, making pre-operative diagnosis extremely difficult.
Key Takeaways from This Case
This remarkable case managed by Dr. Manoj Dongare teaches us several important lessons:
Solitary kidney patients require a surgeon with exceptional vascular and oncological expertise
Pre-operative metanephrine testing is essential before operating on any suspected adrenal tumour
Retroperitoneal tumours near major vessels require careful pre-surgical planning and expert dissection
Previous surgical adhesions add significant complexity — experience matters enormously
Oncocytic pheochromocytoma is a rare diagnosis that can mimic pancreatic or adrenal cysts on imaging
Kidney preservation in a solitary kidney patient is the highest surgical priority
Why Choose Dr. Manoj Dongare for Complex Surgical Cases?
Dr. Manoj Dongare is a highly experienced HPB Surgeon and cancer specialist with expertise in complex retroperitoneal, adrenal, pancreatic, and vascular surgeries. He practises at D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune and Cloverleaf Speciality Clinic, Wakad, Pune-PCMC.
His expertise includes:
Complex retroperitoneal tumour surgery
Adrenal tumour removal with vessel preservation
Solitary kidney cases requiring vascular expertise
HPB and pancreatic surgeries
Rare and unusual oncological presentations
If you or a loved one has been diagnosed with a retroperitoneal tumour, adrenal mass, or any complex abdominal condition, do not delay seeking expert care.
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