Surgical management of an abdominal impalement injury: a case report / Manejo quirúrgico de una lesion por empalamiento abdominal: reporte de caso

Impalement injuries are a complex and rare type of penetrating abdominal trauma that happens when an object such as a post or a pole penetrates a person injuring several organs, making it a life-threatening situation in which time and correct management play an important part in the survival of the patient. A 37-year-old man suffered abdominal impalement injury with a metal signal post, penetrating the left flank of the abdomen. On examination, there is a hypoventilated left hemithorax with intercostal retractions, increased heart rate, weak distal pulses, delayed capillary refill, and pale skin. A 1-meter-long metal post (approximately 7cm diameter) penetrates the left flank with the entry in the posterior lumbar region. Abdominal viscera, omentum, intestinal content, and ischemic loops of the small intestine are visible. An exploratory laparotomy was performed; left hemicolectomy, end colostomy and Hartmann procedure, resection of the affected jejunum, and end-to-end anastomosis were performed. On the ninth postoperative day, an abdominal tomography was performed due to the presence of fever peaks, which reported thrombosis of the left renal artery and emphysematous pyelonephritis, with the presence of a left pararenal collection. A simple left nephrectomy was performed. Postoperative surveillance was satisfactory during the following 5 days. The patient was discharged. An impaled injury is a complex lesion that needs special attention from the medical field for correct management. Although there is some literature about it, we encourage more research to be done about impalement injuries.

Las lesiones por empalamiento son un tipo de traumatismo abdominal penetrante complejo y raro de que se produce cuando un objeto, como un poste o una vara, penetra a una persona lesionando varios órganos, lo que la convierte en una situación potencialmente mortal en la que el tiempo y el manejo correcto juegan un papel importante en la supervivencia del paciente. Un hombre de 37 años sufrió una herida por empalamiento abdominal con un poste de señales de metal, penetrando el flanco izquierdo del abdomen. A la exploración física, hay un hemitórax izquierdo hipoventilado con retracciones intercostales, aumento de la frecuencia cardíaca, pulsos distales débiles, relleno capilar retrasado y piel pálida. Un poste metálico de 1 metro de largo (aproximadamente 7 cm de diámetro) penetra el flanco izquierdo con entrada en la región lumbar posterior. Son visibles las vísceras abdominales, el epiplón, el contenido intestinal y las asas isquémicas del intestino delgado. Se realizó una laparotomía exploradora; Se realizó hemicolectomía izquierda, colostomía terminal y procedimiento de Hartmann, resección del yeyuno afectado y anastomosis terminoterminal. Al noveno día postoperatorio se realiza tomografía abdominal por presencia de picos febriles, que reporta trombosis de arteria renal izquierda y pielonefritis enfisematosa, con presencia de colección pararrenal izquierda. Se realizó nefrectomía izquierda simple. La vigilancia postoperatoria fue satisfactoria durante los siguientes 5 días. El paciente fue dado de alta. Una lesión por empalamiento es una lesión compleja que necesita una atención especial desde el ámbito médico para su correcto manejo. Aunque existe cierta literatura al respecto, alentamos a que se realicen más investigaciones sobre estas lesiones.

Damage Control for renal trauma: the more conservative the surgeon, better for the kidney / Control de daños renal: entr e más conservador sea el cirujano mejor para el riñón

Abstract Urologic trauma is frequently reported in patients with penetrating trauma. Currently, the computerized tomography and vascular approach through angiography/embolization are the standard approaches for renal trauma. However, the management of renal or urinary tract trauma in a patient with hemodynamic instability and criteria for emergency laparotomy, is a topic of discussion. This article presents the consensus of the Trauma and Emergency Surgery Group (CTE) from Cali, for the management of penetrating renal and urinary tract trauma through damage control surgery. Intrasurgical perirenal hematoma characteristics, such as if it is expanding or actively bleeding, can be reference for deciding whether a conservative approach with subsequent radiological studies is possible. However, if there is evidence of severe kidney trauma, surgical exploration is mandatory and entails a high probability of requiring a nephrectomy. Urinary tract damage control should be conservative and deferred, because this type of trauma does not represent a risk in acute trauma management.

Resumen El trauma renal y de las vías urinarias se presenta con relativa frecuencia en pacientes con trauma penetrante. El estándar actual de manejo es realizar una evaluación imagenológica, por medio de tomografía computarizada y un abordaje vascular, a través de técnicas de angiografía/embolización. Sin embargo, el manejo de un paciente hemodinámicamente inestable con criterios de laparotomía de emergencia, con hallazgos de trauma renal o de vías urinarias es aún tema de discusión. El siguiente articulo presenta el consenso del grupo de Cirugía de Trauma y Emergencias (CTE) de Cali respecto al manejo del trauma penetrante renal y de vías urinarias mediante cirugía de control de daños. Las características intra quirúrgicas del hematoma perirrenal tales como si es expansivo o si tiene signos de sangrado activo, son puntos de referencia para decidir entre un abordaje conservador, por estudios imagenológicos posteriores. En cambio, si existe la sospecha de un trauma renal severo, se debe realizar exploración quirúrgica con alta probabilidad de una nefrectomía. El manejo de control de daños de las vías urinarias debe ser conservador y diferido, la lesión de estos órganos no representa un riesgo en el manejo agudo del trauma.

Prothrombin complex concentrate carrying anionic lipid-coated microbubbles enhanced therapeutic ultrasound in hemostatic treatment for renal trauma in rabbits models / 中国医学影像技术

Objective To investigate the hemostatic effects of prothrombin complex concentrate carrying anionic lipid coated microbubbles (PCCMB) enhanced therapeutic ultrasound for renal trauma in rabbits models.Methods Twenty-four healthy New Zealand rabbits were randomly divided into three groups (each n=8),including simple therapeutic ultrasound group (US group),simple PCCMB injection group (SHAM group) and PCCMB injection combined with therapeutic ultrasound group (PCCMB+US group).Visual bleeding score and 10-min bleeding volume were evaluated for hemostatic efficacy.CEUS was used to assess the kidney perfusion in SHAM and PCCMB+US groups before therapeutic ultrasound,immediately and 60 min after therapeutic ultrasound.And CEUS was performed on US group 60 min after therapeutic ultrasound.The acoustic peak intensity (PI) of kidney in rabbit was measured.Results The treatment was successfully completed in all the experimental rabbits.The bleeding scores and the 10-min hemorrhagic volumes decreased significantly in PCCMB+US group compared with the other two groups (both P＜0.05).After therapeutic ultrasound,visual bleeding score of PCCMB+US group was respectively lower than that of US group and SHAM group (both P＜ 0.05).In PCCMB+ US group,PI obtained immediately and 60 min after therapeutic ultrasound were higher than that obtained before therapeutic ultrasound (both P＜0.05).There was no significant difference of PI before and after therapeutic ultrasound in US and SHAM groups (all P＞0.05).Conclusion PCCMB enhanced therapeutic ultrasound provides an effective way for renal trauma in rabbits.

Tratamiento no operatorio en traumatismo cerrado de abdomen en el Hospital Municipal Dr. Leónidas Lucero: nuestra experiencia / Nonoperative treatment of blunt abdominal trauma at the Municipal Hospital Dr. Leonidas Lucero

Antecedentes: existe una tendencia creciente hacia el tratamiento no operatorio (TNO) en el trauma-tismo cerrado de abdomen (TCA), en pacientes estables hemodinámicamente, sin abdomen agudo peritoneal. No hay consenso sobre: momento de inicio de la dieta, deambulación, proflaxis anttrom-bótica, seguimiento y control, y reinicio de la actividad fisica. Objetivo: describir los resultados del manejo de pacientes con TCA, admitidos en nuestro Servicio de Cirugía. Material y métodos: incluimos pacientes mayores de 15 años internados desde enero de 2011 hasta septembre de 2014, con TCA sometidos a TNO. Se recabaron las variables analizadas de una base de datos electrónica de fichaje prospectivo. Resultados: del total de pacientes 31 TCA, 15 se intervinieron quirúrgicamente al ingreso y 16 pacientes se someteron a TNO. El 73,3% presentó lesiones asociadas extraabdominales. A todos se les realizó ecografa abdominal, donde se encontró líquido libre en el 80% y se identificó lesión de órgano sólido en el 60%. En 11 pacientes se realizó TC confrmando lesión objetivada en la ecografa e iden-tificando 3 no evidenciadas previamente. Se diagnosticaron 5 traumatismos hepáticos, 2 asociados a traumatismo renal; 6 traumatismos esplénicos, 4 renales y un paciente con hemoperitoneo. En 7 pacientes se utlizó tromboproflaxis. El TNO fue exitoso en todos los casos. Tres pacientes presentaron complicaciones. No se registró mortalidad. Conclusiones: los pacientes sometidos a TNO en nuestro hospital fueron tratados exitosamente en todos los casos. No se registró mortalidad en la serie analizada.

Background: there is a growing trend towards non-operative management (NOM) in the blunt abdominal trauma (BAT) in hemodynamically stable patentis without peritoneal acute abdomen. However, there is stll no consensus on: tme of onset of diet, ambulaton, antthrombotic prophylaxis, follow-up, and resumpton of physical activity. Objective: to describe the management of patentis with BAT, admited to the Department of Surgery of our insttuton. Material and methods: we included patentis age 15 and older admited from January 2011 to Sept-ember 2014, with BAT who underwent NOM. The variables analyzed were collected from an electronic database of prospective signing. Resultis: 31 TCA were identifed, 15 were operated on at admission and 16 patentis underwent NOM. 75% were men; mean age of 29 (range 18-58). In 100% abdominal ultrasound was performed, finding free fuid in 80% and identifying organ damage in 60% of the total. In 11 patentis CT scan was perfor-med confrming identifed organ injury on ultrasound and diagnosing three not evidenced previously. We included 5 patentis with liver trauma, 2 associated renal trauma; 6 splenic trauma; 4 kidney trauma and 1 patent with hemoperitoneum. Thromboprophylaxis was used in 7 patentis. NOM was successful in all cases. Three patentis presented complicatons, not associated with trauma. No mortality was recorded. Conclusions: patentis undergoing NOT in our hospital were successfully treated in all cases. There were no complicatons associated with management of the NOT. No mortality was recorded.

Urinoma: a rare complication of ureteral calculi.

Urinoma is a collection of extravasated urine either in renal subcapsular or perirenal space. It is caused by obstructive and non-obstructive pathologies. It is rare; with trauma as most common cause in adults and ureteral stones as least common. It mimics symptoms of ureteral stone. CT KUB is best modality to detect it. Here we present a case of ureteral calculi leading to urinomas formation in a 42 years old male patient present with retention of urine and pain in left flank region with nausea, vomiting and fever.

Study on Variations of Posterior Division of Renal Artery.

Background: Kidney transplantation is the treatment of choice for the vast majority of patients with end stage renal disease. Many of the current challenges with the donor grafts are the results of anatomic variants, such as multiple renal arteries, multiple. The previous studies have shown that use of vessel grafts is associated with a higher incidence of vascular and urologic complications. With this back ground the knowledge of variations in vascular pattern is very helpful for renal transplantation and renal surgeries. Materials and Methods: 100 kidneys (Fifty pairs) intact with abdominal aorta were collected from department of Forensic department, JSS Medical College and Mysore Medical College. For study of segmental variation Corrosion cast technique method was used. The variations of posterior division were observed and recorded. Results: In present study type I posterior division of renal artery were found in - 27% cases, type II in - 42% cases, type III in - 25% cases. Conclusion: In present studywe found three types of posterior division of renal artery this knowledge helpful in treatment of renal trauma, renal transplantation, renovascular hypertension, renal artery embolization, vascular reconstruction.

Extravasación urinaria postraumatismo abdominal cerrado: ¿es posible un diagnóstico precoz?: informe de dos casos / Urinary extravasation post blunt abdominal trauma: is it possible an early diagnosis?: report of two cases

La lesión de la vía urinaria superior con extravasación urinaria ocasionada por un traumatismo abdominal cerrado es infrecuente y, a menudo, no reconocida en una evaluación inicial.Un diagnóstico tardío de esta lesión aumenta significativamente la morbilidad. Se presentan dos casos, uno con avulsión de uréter superior derecho y el otro con laceración parenquimatosay de pelvis renal derecha con diagnóstico tardío y complicacionesgraves postraumatismo abdominal cerrado directo. El conocimiento del mecanismo del traumatismo y la evaluación de signos y síntomas locales son datos de importancia parasospechar una lesión pieloureteral, independientemente de la gravedad del traumatismo. La ausencia de hematuria inicial no es infrecuente y su presencia y grado no guarda relación con lagravedad de la lesión. Una tomografía computada abdominal con contraste endovenoso, evaluada en fase excretora tardía, permite la identificación precoz de una extravasación de orina.

An injury to the upper urinary tract with urinary extravasation caused by blunt abdominal trauma is uncommon and often unrecognized in an initial evaluation. A late diagnosis of this injury significantly increases morbidity. Two cases are discussed, one with avulsion of right upper ureter and the other one with parenchymal and right renal pelvis laceration with delayed diagnosis and severe complications subsequent to a direct blunt abdominal trauma. Knowledge of the mechanismof trauma and the assessment of local signs and symptoms are important data for suspecting ureteropelvic injury regardless of the trauma severity. The absence of initial hematuria is notuncommon and their presence and degree is unrelated to the severity of the injury. An abdominal computed tomography with IV contrast evaluated in delayed excretory phase allows an early detection of extravasation of urine.

Effect of extracellular matrix of xenogenic femoral fascia in repair of renal trauma / 中华泌尿外科杂志

Objective To study the effect of extracellular matrix(ECM)of xenogenic femoral fascia which is a tissue-engineering material in repair of renal trauma.Methods Twenty-four experiment dogs were divided into 3 groups:group 1(n=10),the kidneys were repaired using ECM of xenogenic femoral fascia;group 2(n=10),the kidneys were repaired using self-omentum;group 3(n=4),xenogenic femoral fascia was used as repair materials.The animals were sacrificed separately at 1,2 weeks and 1,2,4 months after renal repair operations in group 1,2.In group 3,the animals were sacrificed separately at 2 weeks and 2 months after renal repair operations.The examinations of blood routine were performed before and after operations immediately,blood creatinine and serum renin were measured before operations and before death.The creatinine clearances of affected and contralateral normal kidneys were evaluated before death and the local areas of renal repair were studied by light and scan electron microscopy.Results In group 1,bleeding stopped rapidly and completely after the entire patch was sutured,only mild adhesions to surrounding tissues were found in various times after operations.As time passed,the repair patch was replaced by smooth neocapsule just like a normal one.In group 2,the bleeding volume in the operations was larger than the other 2 groups.It was diffieult tO separate the kidneys from the surrounding tissues.The wounds gradually contracted because of the scar forming.In group 3,there were severe immunological reactions in the patchs.Conclusion ECM of xenogenic femoral fascia is an ideal tissue-enginee rjng material for renal repair.

Trauma renal: diagnóstico, tratamiento y morbimortalidad en pacientes del Hospital Nacional Essalud Guillermo Almenara Irigoyen Lima-Perú: estudio retrospectivo y descriptivo 1999-2005 / Renal trauma: diagnostic, treatment and morbimortality in patient of the Guillermo Almenara Irygoyen Hospital Lima-Perú: retrospective and descriptive study 1999-2005

El trauma renal ocurre en el 1-5 por ciento de todos los traumas, y el riñón es el órgano genitourinario que con más frecuencia se lesiona, con un radio de varón a mujer de 3 a 1. Es objetivo de este estudio evaluar las características de nuestros pacientes al ingreso, el tipo de trauma renal y su estadificación, así como el tratamiento indicado y los resultados del mismo. Todos los pacientes con trauma renal diagnosticado desde el año 1999 hasta el año 2005 en nuestro hospital ingresaron en nuestra base de datos, se encontraron 16 casos con este diagnóstico y con un promedio de edad de 45,25 +/- 19,98 años (24-77) y con un radio varón: mujer de 4 a 1. Hubo 9 de grado I, 6 de grado II y 1 de grado V. El paciente con trauma renal de alto grado fue intervenido quirúrgicamente encontrándose estallamiento renal, y realizándosele nefrectomía con esplenectomía por laceración esplénica asociada. En todos los demás casos sólo se realizó observación y reposo, como se describe también en la literatura.

The renal trauma occurs in the 1-5 percent of all the traumas, and the kidney is the urogenital organ that with more frequency is injured, with a radio of male to woman from 3 to 1. It is objective of this study to evaluate the characteristics of our patients in the income, the type of renal trauma and its grade, as well as the treatment indicated and the results of the same one. All the patients with renal trauma diagnosed since the year 1999 to the year 2005 in our hospital entered in our database, 16 cases with this diagnosis and with an average of age of 45,25 +/- 19,98 (24-77) years were found and with a radio male: woman from 4 to 1. They had 9 of grade I, 6 of grade II and 1 of grade V. The patient with renal trauma of high grade was intervened surgically being found complete renal disruption, and carrying out nefhrectomy with esplenectomy because of splenic laceration associate. In all the other cases only observation was carried out and rest, like it is described also in the literature.

Clinical analysis of the blunt renal trauma / 重庆医科大学学报

Objective:to summarize the experiences of diagnopsis and treatment in the blunt renal trauma,for increasing diag-nostical level and therapeutical results of the renal trauma. Methods:The clinical data of 124 patients with the blunt renal trauma were analysed retrospectively. Results:of 124 cases of the blunt renal trauma,96 were underwent conservative man- agemen(t77.4%),2 were received supra-selectively renal arteral embolization(1.6%),while of 24 cases were administered with surgery(21.4%),14 associated with intra-abdominal injuries. At last,2 died of the renal renal injuries,accounting for 1.6%. Conclusion:Ultrasound type B plus CT scaning are important and effective techniques for diagnosis of the kindy injury. The high-dose intravenous pyelogram remains an excellent tool for assessing renal trauma.

Trauma renal, a propósito de un caso / Renal trauma, case report

Se presenta el caso de una paciente de 9 años de edad con antecedente de trauma renal grado IV, a la que tubo que realizarse nefrectomía. La conducta quirúrgica se determino por los hallazgos de exámenes complementarios como la urografía endovenosa. Actualmente se considera que el tratamiento conservador es una opción en la mayoría de los paciente con trauma renal, existiendo pocas indicaciones para una conducta quirúrgica en este tipo de pacientes. Es de vital importancia la adecuada interpretación de los exámenes complementarios para determinar una conducta. Se aprovecha el caso clínico para realizar una revisión de la literatura.

The case of a patient of 9 years of age with antecedent of renal trauma appears degree IV, to which to be made nefrectomy. The conduct I determine myself by the complementary findings of examines like urografhy. At the moment it is considered that the preservative treatment is an option in mayor of the patient with renal trauma, existing few indications for a quirurgica conduct in this type of patients. It is of vital importance the suitable interpretation of examination complementary to determine a conduct.

The role of imaging examination in diagnosis and management of renal trauma

The generalization of some comments about the role of imaging examination in diagnosis of renal trauma as non-preparative adominal tomography: has less value in diagnosis of renal trauma but helps to detect metanephric duct stone. Intravenous urography (UIV): these imagings are main to evaluate the rest of renal function, prevention of cases of traumatic renal excision, has less value in diagnosis of renal trauma. Adominal ultrasound: to detect suggestive signs of internal haemorrhage due to solid viscera breaking in abdomen. CT scan has an important role, to help identifying with or without renal trauma, the level of renal lesions, with or without other viscera lesions. Renal angiography: to block selectively vessels to make haemostatic in some cases of haemorrhage due to renal trauma. MRI is recommended for patients with contraindication of absolute using contrast media

Characteristic ultrasonography imaging of renal trauma at Viet Tiep hospital, Hai Phong

Determine ultrasonic features of renal trauma patients at Viet Tiep Hospital, Hai Phong city. Subject: 21 renal trauma patients (14 males and 7 females) with mean age 30.71±13.85 years treated from April 2001 to April 2002. Method: Use ultrasound examination, classify renal trauma. Results: ultrasound examination is 1st choice of imaging diagnosis because it is fast, noninvasive, and easy using in emergency situations. Among 21 renal trauma patients (13 patients in grade I, 2 patients in grade II, and 6 patients in grade III), ultrasonic findings were contusion and parenchymal hematoma (71.42%), rupture (swallow or deep) (28.57%), perirenal hematoma (23.81%). In cases of grade III renal trauma, ultrasound imagines showed shallow or deep rupture (5 of 6 cases) and perirenal hematoma (4 of 6 cases)

Assessment of renal trauma by ultrasound contrast via vein / 第三军医大学学报

0.05) before and after the contrast.However,for the renal parenchyma,it increased significantly after the contrast(P

Renal Trauma in Abdominal and Thoracic Stab Injury: Comparison of Incidence and Degree of Injury According to the Stab Entrance Site / 대한비뇨기과학회지

PURPOSE: To evaluate the incidence and degree of renal injury, according to the site of entry in patients admitted with abdominal and thoracic stab injuries. MATERIALS AND METHODS: Between April 1991 and March 2002, 158 patients that were admitted to the departments of urology, and general and thoracic surgeries due to abdominal and thoracic stab injuries, with or without renal trauma, were included in this study. We reviewed our clinical records to clarify the frequency of renal trauma, associated intra-abdominal injuries, the risk of renal trauma, according to the site of entry, and their treatments. RESULTS: The overall incidence of renal trauma was 15% (24 of 158 patients), and one fourth of all the abdominal and thoracic stab injuries. There was a 75% frequency of associated intra-abdominal injuries, with small bowel, liver, colon and the chest being the most commonly injured organs. Of the 158 patients, 77 and 24 were related to abdominal and flank penetration, and of these 5 (6%) and 10 (42%) presented with renal trauma, respectively. CONCLUSIONS: The incidence of renal trauma in the admitted patients with abdominal and thoracic stab injuries can be expected to have a probability of 15%, and when the entrance site is the flank or back, the risk of renal trauma may be increased.

The value of ultrasound in diagnosis of closed renal trauma

The study involved 63 patients (48 males, 15 females) aged from 10 to 64 years old with renal trauma who were undergoing operation at ViÖt Nam - Germany Hospital between 1/1991 and 7/1998. Direct and indirect signs of renal trauma and the value of ultrasound in evaluation and classification of damage were investigated. The results showed that ultrasound is a simple, non-invasive and harmless method. It provided high diagnostic value for most of signs of renal trauma such as change in shape, damage in tissue, kidney rupture and hematoma in post-peritoneal cavities. Ultrasound can also access closely to anatomical classification of renal trauma with high accuracy in diagnosis.

Is There a Role of Magnetic Resonance Imaging for Renal Trauma / 대한비뇨기과학회지

PURPOSE: Computed tomography (CT) has been the most informative imaging in renal trauma. Despite the good sensitivity of magnetic resonance (MR) imaging to the presence of hematuria, edema and ischemia, MR imaging has not been widely studied in patients with renal trauma. This present study was initiated to evaluate the role of MR imaging in patient with renal trauma. MATERIALS AND METHODS: We prospectively reviewed the imaging of CT and MR imaging of 13 patients who suffered from renal trauma. RESULTS: The presence and size of perirenal hematoma could be detected in both CT and MR imaging. However, MR imaging provided additional information about the onset of hematoma and could differentiate subcapsular hematoma from perirenal hamatoma more accurately. Focal renal infarction that was differentiated difficultly from perirenal hematoma on CT could be easily identified on MR imaging. CONCLUSIONS: MR imaging determine the extent of parenchymal laceration and the status of perirenal hematoma, renal infaction and renal fragment more accurately than CT. Moreover, MR imaging has advantages including lack of ionizing radiation and no routine need for intravenous contrast medium. Therefore, we suggest that MR imaging can alternate CT in selected cases.

The Significance of Abdominal Ultrasonography as the Initial Diagnostic Method in Blunt Renal Trauma / 대한비뇨기과학회지

PURPOSE: To evaluated the effectiveness of abdominal ultrasonography as the initial diagnostic method in blunt renal trauma. MATERIALS AND METHODS: This study was undertaken to compare computerized tomography with abdominal ultrasonography in radiographic staging of blunt renal trauma(Renal Injury scale grade I-V by Moor) except vascular injury. During 3-years period(May 1994 to March 1997), emergency computerized tomography was performed in 66 patients with blunt renal trauma, simultaneously 34 patients among 66 patient were scanned by abdominal ultrasonography. RESULTS: Gross hematuria were present 48% of renal trauma cases. The degree of hematuria showed not correlation with the severity of renal injury(p-value=0.213, by Chi-square test). In diagnostic agreement of abdominal ultrasonography compared to computerized tomography, the diagnostic agreement of minor renal injury(x=0.544, by k2 statistics) was higher than that of major renal injury(r=0.375, by k2 statistics). The overall diagnostic agreement of abdominal ultrasonography in detecting adjacent organ injury was 0.321 (k value). CONCLUSIONS: In ultrasonography imaging, we concluded that minor blunt rectal trauma is not necessary other radiologic evaluation, but major blunt renal trauma should be evaluated by computerized tomography for proper diagnosis of combined injury and diagnostic staging of renal trauma. Renal trauma associated Intraabdominal injury should undergo with ultrasonography-guided paracentesis. Based under result of our study, we suggest the use of abdominal ultrasonography as the initial diagnostic method in blunt renal trauma compatible for prompt diagnosis and treatment.

Kidney Preserving Surgery in Renal Trauma:. Experience by Early Vascular Approach Technique / 대한비뇨기과학회지

PURPOSE: To evaluate the usefulness and safety of unified technique of vascular control before renal exposure in reconstructive surgery of renal trauma. MATERIALS AND METHODS: From July 1995 to June 1997, 10 patients with major renal trauma who operated by unified approach technique were included in this study. Blunt trauma was the mechanism of injury in 8 patients and 2 were resulted from penetrating(stab) injury. Of the injuries 2 were grade 3, 7 grade 4, 1 grade 5. RESULTS: Of the 10 patients, 8(80%) were performed kidney preserving surgery and 2(20%) resulted in nephrectomy. Partial nephrectomy was underwent in 6 patients(with vascular repair in 2 cases) and renorrhaphy in 2 patients. Pedicle flap of omentum was used mainly and polyglycolic acid mesh also used in 2 cases as coverage material of parenchymal defect. Complications occurred in 2 cases(20%) but none resulted in renal loss with the mean followup of 10 months(1 to 15 months). CONCLUSIONS: Unified approach technique of vascular control before renal exposure seems to be a safe and effective method for reconstructive surgery in renal trauma. To confirm this result, studies with more cases and longer followup are needed.

Renal trauma

A total of 190 patients were treated from 1/1995 to 5/2000. We use the classification of ATT bases on the on the clinical signs and imaging diagnosis. Basing on the conservative and operative treatment, we assessed the possibility of conservative treatment on normal and pathological kidneys. Results: 190 patients consist of 104 moderate cases, 86 severe cases. 83 cases are of right kidneys and 107 are of left kidney. 30 cases are of pathological Kidneys. 92 cases were operated Nephrectomy was 67%, the conservative treatment was 33%.