450 Indian Journal of Urology, Oct-Dec 2014, Vol 30, Issue 4 Massive left hemothorax following laparoscopic pyeloplasty Manjula Rao, Nischith D’Souza, Altaf Khan, Mujeebu Rahiman Department of Urology, Yenepoya Medical College, Mangalore, Karnataka, India ABSTRACT Laparoscopic pyeloplasty is viable standard minimally invasive alternative to open pyeloplasty for the treatment of ureteropelvic junction obstruction. Intrathoracic bleeding is an extremely rare complication after laparoscopic urological surgery, but it should be suspected and promptly diagnosed in case of worsening hemodynamic status and respiratory parameters during the intra or post‑operative course. We report a case of hemothorax complicating an otherwise uneventful LP in an 18‑year‑old girl. Key words: Complications, hemothorax, laparoscopic pyeloplasty For correspondence: Dr. Nischith D’Souza, Department of Urology, Yenepoya Medical College, University Road, Deralakatte, Mangalore ‑ 575 018, Karnataka, India. E‑mail: docmanjrao@gmail.com INTRODUCTION Laparoscopic pyeloplasty (LP) is a minimally invasive alternative to open pyeloplasty for the treatment of ureteropelvic junction obstruction. It has been shown to provide lower patient morbidity, shorter hospitalization and faster convalescence. However, there is an inherent risk of surgical (blind trocar insertion, colonic injury, hemorrhage, ileus, urinoma formation) and anesthetic complications (gas embolism, extraperitoneal insufflation and surgical emphysema, pneumothorax and pneumomediastinum). [1] We report an isolated case of hemothorax, complicating an otherwise uneventful LP. CASE REPORT An 18‑year‑old girl was diagnosed to have left pelviureteral junction obstruction during evaluation of left flank pain. A transperitoneal LP was planned. The Veress ® needle insertion and insufflation was uneventful. High resolution camera and monitor systems were used. Surgical cautery was used for dissection. Three trocars, including a 10 mm umbilical trocar, a 10 mm trocar midway between the umbilicus and the symphysis, and a 5 mm trocar midway between the umbilicus and xiphoid were used. Pneumo‑peritoneum was kept constant at 12 cm H 2 O. No impairment of respiratory parameters was observed by the anesthesiologist during the procedure. The entire procedure was completed in 90 minutes, and a drain was placed after confirming hemostasis. However, at the end of the procedure, before evacuation of pneumoperitoneum, the patient developed hypotension. This was initially responsive to fluid administration, but quickly deteriorated after weaning, resulting in severe hypovolemic shock with worsening of respiratory parameters (tidal volumes, peak pressures and blood gases). An on‑table clinical examination suggested decreased air entry in the left hemithorax. A pneumothorax was suspected, and a needle was inserted into the left fifth intercostal space. However, it drained blood and a chest X‑ray revealed a hazy left hemithorax. Screening ultrasound and contrast enhanced chest computed tomography (CT) scan showed a massive hemothorax with no hemoperitoneum (ultrasound and CT installations are within the operation theatre complex). A 28 French intercostal tube was inserted in the left fifth intercostal space, and 2 L of blood was drained. The patient continued to remain hypotensive despite resuscitation and blood transfusion and more than 500 ml blood drained through the intercostal tube during the subsequent 2 h. Access this article online Quick Response Code: Website: www.indianjurol.com DOI: 10.4103/0970-1591.139590 Case Report