according to the eau guidelines   nephron - sparing surgery ( nss ) has a similar oncological outcome to that of radical surgery . however , nss is not suitable in some patients with localized renal cell carcinoma ( rcc ) because : 1 ) of locally advanced tumor growth , 2 ) partial resection is not technically feasible because the tumor is in an unfavorable location , 3 ) and/or significant deterioration of the patient 's general health . in these situations
the gold standard curative therapy remains radical nephrectomy , which includes radical removal of the tumor - bearing kidney .
acute pancreatitis has not yet been described in the published literature as a complication of radical nephrectomy .
a 56-year - old patient was referred to the department of urology at the medical university of graz for right renal tumor ( ct scan verified a 12 cm renal mass ) to perform a radical nephrectomy .
the preoperative anesthetic screening of our patient showed asa ii according to the american association of anesthesiology and well - controlled hypertension with normal laboratory blood tests .
there were no co - existing infections the histological examination of the right kidney revealed a renal cell carcinoma ( rcc ) .
the operation was uneventful . however , one day later the patient complained of gradually increasing , serious abdominal and back pain , including jaundice and fever . on physical examination ,
the patient had neither a history of biliary lithiasis nor chronic alcohol consumption or infections .
laboratory data ( blood ) demonstrated urea 61 mg / dl ( n : 10 - 45 ) , uric acid 8.5 mg / dl ( n : 3.4 - 7 ) , potassium 4.3 mmol/ ( n : 3.5 - 5 ) , calcium 1.99 mmol / l ( n : 2.202.65 ) , aspartate aminotransferase 216 iu / l ( n : 0 - 35 ) , alanine aminotransferase 134 iu / l ( n:0 - 45 ) , lactate dehydrogenase 404 iu / l ( n:120 - 240 ) and amylase 989 iu / l ( n : 13 - 53 ) , lipase 2154 ( 0 - 60 ) , and procalcitonin 3.45 ( n:0 - 0.5 ) .
white blood cell count was also raised ( 13000 ) , as well as crp 268 mg / l ( n:0 - 8 ) , bilirubin 1.43 ( n:0.1 - 1.2 mg / dl ) , and creatinine 2.78 mg / dl ( 0.6 - 1.3 ) .
an abdominal ct scan was performed and demonstrated parenchymal edema of the pancreas ( figs . 1 and 2 ) .
the patient was referred to the intensive care unit and treated conservatively for 15 days  his medical condition improved and he was referred to the department of gastroenterology , where mr cholangiopancreatography showed no biliary stones , and a normal liver .
the international symposium on acute pancreatitis in 1992 defined pancreatic necrosis as the presence of one or more diffuse or focal areas of non - viable pancreatic parenchyma .
so , based on the patient 's clinical presentation and ct scan findings , the diagnosis of acute pancreatitis   as a complication of radical nephrectomy was considered .
the patient was referred to the intensive care unit ( icu ) and oral intake was prohibited .
a nasogastric tube was inserted for decompression and parenteral nutrition was started from a central vein .
ten days later , serum pancreatic enzyme levels and white blood cell count returned to normal ranges
bowel movements became normal , and the patient passed stool . on the same day , the nasogastric tube was removed and restricted oral intake was permitted . on day 16
transperitoneal radical open nephrectomy is a generally accepted treatment for a renal mass greater than 10 cm in size . in the published literature
according to burkey   retroperitoneal dissection and ischemia could be risk factors for postoperative pancreatitis . however , this was not the case in our patient and trauma to the head of pancreas was avoided .
according to milian et al   the mortality rate of pancreatitis was 8.3% for conservative medical treatment versus 26.5% for surgical treatment .
physicians should consider pancreatitis as a potentially life - threatening adverse event associated with propofol [ 6 , 7 ] , which may be due to failure of free fatty acid metabolism secondary to inhibition of free fatty acid entry into the mitochondria .
we hypothesize that propofol could have played a role in the pathophysiology in this condition , because no biliary stone was demonstrated on preoperative or postoperative radiologic studies in the presented case . additionally , no other predisposing factors ( e.g. alcohol , infection , addiction or hypercalcemia as well as history of chronic pancreatitis ) for pancreatitis were present in our patient .
 radical open nephrectomy is considered the standard treatment for kidney tumors or masses greater than 10 cm . 
 we present a rare case of acute pancreatitis that occurred after right radical transperitoneal nephrectomy , which was treated by nonsurgical conservative interventions.the incidence of acute pancreatitis after renal surgery is not known in the literature.a 56-year - old man developed acute pancreatitis postoperatively after radical transperitoneal nephrectomy . 
 an initial ct scan showed an enlarged pancreas with hypodense , heterogeneous consistency and with peripancreatic , perihepatic , mesenteric , and pelvic fluid collections . 
 this complication was managed conservatively . 
INTRODUCTION
CASE REPORT
DISCUSSION