Blunt Renal Trauma in a Pre-Existing Renal Lesion

Abstract

A 70-year-old male presented with direct trauma to his loin with gross hematuria, as an isolated case of blunt renal trauma (BRT) due to a traffic accident. A pre-existing renal lesion (PERL) was strongly suspected by his past history of gross macroscopic hematuria and monotrauma to the kidney without other associated injuries. Spiral CT scan with contrast and a retrograde pyelogram (RGP) confirmed an occult complex renal cyst. The gold standard of CT diagnosis in this situation is stressed. Computed tomography is particularly useful in evaluating traumatic injuries to kidneys with pre-existing abnormalities. The decision on the initial course of conservative management, ureteral retrograde stenting to drain extravasation, and its final outcome are discussed. Radical nephroureterectomy was carried out by a transperitoneal approach with an early vascular control of the renal pedicle. A brief review of recent literature has been undertaken.

Rupture of the Renal Pelvis of a Ureteropelvic Junction Hydronephrosis After Blunt Abdominal Trauma

“…The aim of management is to prevent mortality, conserve the kidney, and reduce immediate and long-term morbidity [11].…”

“…No consensus exists regarding the follow-up schedule. Based on an observed healing pattern on CT, one particular protocol recommends CT and radioisotope scans to detect any complications and to determine residual renal function [11].…”

“…There is a predisposition for different types of injuries on each side. The left kidney is not covered by the liver, is less mobile due to its additional ligamentous attachments (splenorenal and phrenocolic), and has fewer bare areas [11].…”