CONSERVATIVE OR SURGICAL TREATMENT FOR BLUNT RENAL TRAUMA

Abstract

Whether patients with blunt renal trauma should be mana ged conservatively without surgery or undergo surgery is often hard to decide. We describe three clinical cases of blunt renal trauma, all involving the left kidney. All three patients had abdominal ultrasound studies and computeri zed tomographic (CT) scans. In the first case, an acciden tal fall led to severe injury of the renal hilus causing mas sive retroperitoneal extravasation. The patient underwent emergency nephrectomy and survived. The second case con cerned a patient who was involved in a road accident, suf fered injuries mainly affecting the spleen, and underwent splenectomy. A postoperative CT scan showed left renal vein thrombosis functionally excluding the inferior pole of the kidney. The patient received conservative non surgical treat ment. A follow-up imaging study showed that although the thrombosis had resolved the renal pole had failed to regain normal function. In the third case, mild apparently unim portant trauma led to a massive hemorrhage responsible for a severe shock state. Despite prompt nephrectomy, renal fai lure and and pulmonary complications developed and one month after the injuries the patient died. The medical history referred to a “chronic hematoma” secondary to a childhood injury. In this case, the pre-existing hematoma probably led to a permanent communication with the vascu lar and excretory tree thus resulting in a kind of “silent” fistula that the relatively mild injury unexpectedly disrup ted. For the two left nephrectomies we used a midline approach after isolating the renal Treitz vessels; special care was taken to mobilize the left colon. Although blunt renal trauma often responds to non surgical conservative treat ment, some patients should undergo prompt surgery. All patients must be scheduled for long-term clinical and ima ging follow-up.