Title : Iatrogenic pneumothorax following nephrectomy: Case report
Abstract:
Iatrogenic pneumothorax is a rare but potentially serious complication of nephrectomy, especially in open procedures involving subcostal or lombotomy approaches. The anatomical proximity of the kidney to the pleura and diaphragm increases the risk of pleural injury. We report a case of symptomatic postoperative pneumothorax following left nephrectomy in a young patient, underlining diagnostic challenges and therapeutic strategies.
Case Report: A 22-year-old Mauritanian woman with no relevant medical or surgical history presented with chronic intermittent left-sided lumbar pain. Imaging revealed severe left hydronephrosis due to ureteropelvic junction obstruction, with significant parenchymal thinning and no evidence of stones. A non-functional kidney led to the decision to perform a left nephrectomy via subcostal lombotomy. During surgery, a pleural breach was detected and sutured after lung re-expansion. On postoperative day 2, the patient developed acute chest pain and respiratory distress. Clinical examination and thoracic CT confirmed a large left-sided pneumothorax. Chest tube drainage with suction was performed, leading to rapid improvement. By postoperative day 5, the drain was removed. On day 7, a chest X-ray revealed a partial residual left pneumothorax with minimal effusion. A conservative management strategy with oxygen therapy was adopted, achieving full re-expansion by day 10.
Conclusion: Iatrogenic pneumothorax following nephrectomy remains an uncommon but clinically significant complication. Intraoperative vigilance is essential to minimize pleural injury, and in hemodynamically stable patients, conservative strategies such as oxygen therapy and radiologic surveillance may be sufficient. Early recognition and tailored management are crucial to optimize outcomes.
