Fig. 5

Two days after L-NSS for T1N0M0 RCC of the right kidney, the same patient as in Fig. 1a, b suffered from abdominal pain and progressive blood loss (nadir haemoglobin 11.5 g/dL), with stable vital signs. Urgent CT images viewed at lung window settings (a) showed moderate pneumoperitoneum (arrowheads) and subcutaneous emphysema of the abdominal wall (+). Unenhanced (b) and post-contrast (c–f) image showed the renal resection site (arrows in b–d) with sutures (thin arrows), a sizeable haematoma centred in the posterior para-renal space (*) causing kidney displacement, without active bleeding. Coronal CT reformation (f) confirmed massive subcutaneous emphysema (+) and pneumoperitoneum (arrowhead). Following conservative treatment and drainage tube repositioning, repeated CT 5 days later (g) showed persistent subcutaneous emphysema (+), decreased retroperitoneal blood collection (*)