1. CT scan of the abdomen Huge mass lesion
Left hemoperitoneum, to consider renal malignancy.
Infiltration of the colon cannot be ruled out.
Partial small bowel obstruction and minimal left pleural effusion.

2. Left nephrectomy with left hemicolectomy
March 3, 2011

3. Operative Technique
1. GETA 2. Asepsis and antispesis 3. Sterile draping 4. Midline excision 5. Exploration 6. Adhesiolysis 7. En bloc excision of mass 8. Left hemicolectomy 9. Left nephrectomy 10. End to end primary anastomosis 11. Hemostasis 12. Placement of clips 13. JP drain placement 14. Closure layer by layer 15. Sterile dressing

12. OR Findings
Retroperitoneal mass with multinodular with solid and cystic component approximately 30 x 28 x 30 cm.
Left middle colic artery, descending colon, left ureter and left kidney were noted to be adherent to the mass.
A midline excision was done and upon opening, a 30 x 28 x 30 cm multinodular mass with solid and cystic component was noted with its attachment from the retroperitoneal area. The left middle colic artery, descending colon, left ureter and left kidney were noted to be adherent to the mass. After adhesiolysis, en block excision of the mass was performed subsequent left hemicolectomy. Inadvertently, the left ureter was severed from its distal end. With the mass connected to the left kidney, an intraoperative referral to urology was done. Grossly, the right kidney appeared viable, with a normal Creatinine pre-operatively, left nephrectomy was performed. This was followed by primary anastomosis. A JP drain was placed prior to closure. Post-operative determination of Creatinine turned out normal.

13. HISTOPATH PICS