British Jurtrrrul u/' Urologv (1976). 48, 106 0

Short Case Report

A Complication of Nephrectomy by the Supracosta1 Approach Turner-Warwick (1965) described many ad- vantages of the supracostal approach to the kidney with rib preservation. Because of these advantages this incision has been used by one of the authors, without complication, for 5 years. We now report an unusual complica- tion of the incision which resulted from in- complete mobilisation of the supports of the 12th rib.

Case Report

A 55-year-old male underwent left nephrectomy using a supra I2 incision. Recovery was complicated by a wound infection due to Staph. aureus. Despite appro- priate antibiotics this developed into a sinus which was surgically explored 4 months later. A sequestrum of the tip of the 12th rib was removed, together with the remainder of the bone (Fig.). The patient made an uneventful recovery and the wound healed completely.

Pathological examination of the specimen showed active osteomyelitis, a sequestrum and cloaca.

Comment

The usual cause of persistent wound sinus after nephrectoniy is infection associated with non-absorbable ligatures. Osteomyelitis of the rib has not been reported. In this case fracture of the rib followed incomplete division of the supracostal supports. I f this is recognised during operation we would rc- commend excision of the rib fragment.

G O I W ~ N WILLIAMS and J . E. CAsrRo Urological and Tratrsplantation Uirit, R o j d fo.c.t- graduate Medical School. Haninic,r.snrirlr Hospitul, f lu Cane Road, L v n r h WI2 OHS

Reference

TURNER-WARWICK, R . T. (1965). The supracostal approach to the renal area. Uritidr Jorrrtral of' Uroloxy, 37, 67 1-67?,

Fig. Excised 12th rib showing sequestrum with cloaca of the tip ( R . H . S . ) . 106