Gangrene of the Kidney Following Percutaneous Renal Cryoablation of a Small Tumor.

In selected cases cryoablation is a valid treatment option for small renal masses. The procedure is generally considered oncologically efficient with a low rate of severe complications. We report here a case of a 62-year-old man who after percutaneous cryoablation develops severe gangrene in the treated kidney. A 62-year-old man was incidentally diagnosed with a 45-mm renal cell carcinoma. The tumor was found on a CT scan performed on the suspicion of diverticulitis. An abscess in relation to the sigmoid was found and he was treated with aspiration and antibiotics. The tumor was treated with percutaneous cryoablation 20 days later. On the third postoperative day, he was readmitted with urosepsis. A CT scan revealed gangrene at the ablation site, and a nephrectomy was performed. Clinical progress was slow, and a new CT scan showed reformation of the abscess at the sigmoid and a suspicion of a colonic tumor was raised. This was confirmed by coloscopy and biopsy. The patient had a right hemicolectomy, and the pathology report described a T4 adenocarcinoma with positive margins. After 4 months follow-up, metastases to the lungs was found and the patient was referred to further oncologic treatment. Renal cryoablation is generally a very safe procedure, but severe complications may occur. This case report highlights that attention should be given to recent abdominal infections and that delayed intervention might be in place in selected cases.