{UAH} Old Kampala hospital explains the missing kidney

Dear colleagues,

Thank you for contacting me to clarify what is spreading on social media, and surely it will end up in some local newspapers without cross-checking with the experts on the field.

In summary, in a simplified language, the gentleman claiming for his kidney may probably have a (congenital ) unilateral renal agenesis , that simply means he was born with 1 kidney instead of 2 (solitary Kidney, about 2 over 1000 people have this anomaly). It is a rare anomaly that one can leave with all his life unnoticed if never checked. Usually it is found when checking for other problems.

Based on the phone call conversation I had with his attending Doctor, the patient was involved in accident, had injury on the front of his head, had a cracked frontal and nose bones with CFS (Cerebrospinal fluid)/ water from the brain was leaking through the fracture defect in the nose. 

The medical treatment of this type of injury and condition is to lift the cracked bones, to fix the envelopes (dura matter) covering the brain, and to seal the defect where the brain water was leaking. In most case, to avoid CSF to leak after your operation, you need to make sure the defect is properly sealed. To seal that defect tightly, there are several ways depending on your hospital settings and charges. 

During the operation, the first objective is to close the envelope that covers the brain (called Dura), then use a fat from the tummy, or wax, or synthetic materials. Sometimes neurosurgeons use some small metals to stabilize the repaired bones properly. 

If the patient refuses to have the surgery, or if the doctor thinks otherwise, it is possible to observe this injury to stop leaking CSF by itself, but the patient's face will look sunken still. But when there is an open wound, it is advised to do the surgery as quick as possible to prevent infection entering in the brain, that is a deadly complication. Similar operations like this one on the brain are done frequently like 2 to 3 cases in a week in Mulago hospital. 

For this patient, he was taken to surgery by a qualified Neurosurgeon who did the correct thing, and the patient was briefed about the procedure and the possibility of taking some fat from the wall of his tummy in order to seal the defect where water is leaking, and he will have an incision in that tummy after. He consented for the surgery as explained. 

During the operation in that private, under general anesthesia (patient is sleeping deeply) it was found that his has an open wound on the front, his frontal bone was cracked down, his brain envelope was torn, leaking water (CSF) through. The Neurosurgeon washed out and cleaned his wound, repair his broken bone, fixed his torn dura (Brain envelope), and remove all the dirty materials. He then open the wall of the left tummy, took some fat that is just superficial after the skin, then closed that new wound of the tummy. He then put the piece of fat between the dura and the bones separating the brain and the nose, and closed the wound. He then put a bandage over it. The patient was managed well upto discharge. 

What went wrong is that people convinced patient that something was unusual to have an injury on the head, but the doctor did an operation on his tummy. Unfortunately it was a rare coincidence that the incision was just on the side of the absent kidney based on the scans he did later.

For your information, to remove someone kidney is a relatively major operation done in special theatres with special containers and kits as recommended. The incision is done on the side or a large incision on the middle if you open the tummy because the kidney is a bit behind (and not in front as we can see in the social media picture). 

If they remove the kidney, you will see some blood clots in the space where was the kidney, but also many internal organs may look like displaced but the scan reports don't mention this fact.

In short, there was no kidney harvesting and I advise that we stop spoiling the images of our medical fraternity that is doing a great job.

Thank you!

*Dr. Frank Rubabinda*

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