Renal Rim Mystery Post Hysterectomy: A Case Report of Acute Cortical Necrosis

Background: Acute cortical necrosis (ACN) is an uncommon but severe cause of acute kidney injury, accounting for 6-7% of cases in developing countries.While obstetric causes such as postpartum hemorrhage and eclampsia are more frequently implicated, non-obstetric causes are rarely reported.Early recognition is vital, as the condition often leads to irreversible renal failure and dialysis dependence.Methods: We describe the clinical course of a 34-year-old female who developed ACN following abdominal surgery.Patient details, clinical presentation, laboratory investigations, imaging studies, treatment, and short-term outcome were systematically documented.Results: On the fifth postoperative day after total abdominal hysterectomy, the patient presented with abdominal pain, decreased urine output, and haematuria.Laboratory evaluation showed anemia, leukocytosis, hyperbilirubinemia, transaminitis, and severely deranged renal parameters (serum creatinine 7.76 mg/dL, blood urea 257 mg/dL).Blood culture grew Klebsiella pneumoniae.Computed tomography revealed the characteristic "reverse rim sign" with subcapsular cortical hypodensity, confirming ACN.The patient was managed in intensive care with intravenous antibiotics, diuretics, supportive measures, and two sessions of hemodialysis.Gradual symptomatic relief and partial renal recovery were observed, although dialysis dependence was anticipated at discharge.Conclusion: This case highlights the occurrence of ACN as a rare non-obstetric complication following abdominal surgery.Radiological findings, particularly the reverse rim sign on CT, play a crucial role in early diagnosis.Prompt initiation of hemodialysis and supportive management can improve survival, though progression to end-stage renal disease is common.Awareness of this entity is essential to avoid diagnostic delay and to optimize patient outcomes.