case_images: PMC11786649_01
case_images: Composite preoperative images (A) Abdominal ultrasonography and (B) computed tomography (CT) during pregnancy demonstrates a huge cystic lesion (B, arrowheads) on the outer side of the left kidney. (C) Retrograde pyelography and (D) contrast-enhanced CT after delivery reveal a calyceal diverticulum with a small fistula (arrows) communicating with the renal pelvis.
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case_images: Ultrasonography revealed a cystic lesion measuring 18 x 15 cm on the left kidney, which was thought to be a simple renal cyst (Fig. 1A). We placed a 6-Fr pigtail catheter into the lesion and performed plain computed tomography (CT), which revealed findings consistent with a simple renal cyst (Fig. 1B). Contrast-enhanced CT and retrograde pyelography revealed a cystic lesion communicating with the renal calyx through a small fistula (Fig. 1C and D).
case_images: Port placement and appearance of calyceal diverticulum (A) Schematic of port placement: circles, 8-mm robotic ports; square, 8-mm camera port; triangle, 5-mm assistant port; double circle, 12-mm assistant port; distance between each port is 7 cm. (B) Calyceal diverticulum.
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case_images: The port placement is shown in Fig. 2A. Excision of the diverticular wall revealed a fistula that appeared to be a diverticular orifice (Fig. 2, Fig. 3A, B).
case_images: Surgical precedure (A) Resection of the diverticular wall and identification of the fistula. (B) Proximal view of fistula (arrowheads). (C) Closure of the fistula with continuous suturing. (D) Cautery of the diverticular lumen using monopolar soft coagulation. (E) The fistula closure is sealed using a tissue adhesive sheet. (F) Renorrhaphy with sliding clip technique.
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case_images: The fistula was closed by continuous suturing using 4-0 poliglecaprone (Monocryl) in a watertight fashion (Fig. 3C). The diverticular lumen was cauterized using monopolar soft coagulation, and the fistula closure was sealed using a tissue adhesive sheet (TachoSil; CSL Behring Japan, Tokyo, Japan) (Fig. 3D and E). Finally, we performed renorrhaphy with the sliding-clip technique using a V-Loc wound closure device with a 2-0 suture (Covidien , Mansfield, MA, USA) (Fig. 3F).
case_images: Histopathologic findings (A) Gross view of the cyst wall. (B) Microscopy (hematoxylin and eosin staining) shows a cyst wall covered with erosive inflamed urothelium, consistent with a calyceal diverticulum.
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case_images: Histologic examination revealed a cyst wall covered with urothelium, confirming the final diagnosis of CD (Fig. 4).
case_images: Postoperative findings (A) Contrast enhanced CT shows no evidence of recurrence of the calyceal diverticulum 5 months after surgery. (B) Renal function over time. s-Cr, serum creatinine; eGFR, estimated glomerular filtration rate.
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case_images: There has been no evidence of diverticulum recurrence on CT 5 months after surgery and no deterioration of renal function (Fig. 5).