Experiences of Conflict Zone-Related Ballistic Renal Injury

Abstract

To analyze our approaches and experiences in patients with renal injuries accompanying penetrating abdominal injuries admitted to the hospital due to high kinetic energy weapons. Patients including renal injuries associated with penetrating abdominal injuries due to gunshot wounds and fragments of shell treated at our institution between February 2002 and May 2013 were retrospectively analyzed. Total 21 patients were included in this study, 20 of whom (86.2 %) were male and 1 (13.8 %) female. Renal injury was scaled in 2 patients as grade 1, 4 patients as grade 2, 4 patients as grade 3, 8 patients as grade 4, and 3 patients as grade 5. While conservative treatment was applied to patients with grade 1 and 2 injuries, 2 patients with grade 3 injury underwent renal repair and the other 13 patients underwent nephrectomy. The amount of blood transfused in all cases was determined to be mean 8.28 (6-16) units for red blood cells (ES) and 9 (6-17) units for fresh frozen plasma. When patients were assessed according to the Penetrating Abdominal Trauma Index (PATI) scores, the median score and average PATI score were 35 and 37.6 (10-70), respectively. A physical examination along with a quick assessment of vital signs should be made, and unnecessary and time-consuming investigations such as abdominal tomography and angiographic intervention should be avoided. Conservative and organ preservation should be considered absolutely for appropriately selected patients, namely in stable patients in whom kinetic energy transfer is less and who have bullet path away from midline. However, the majority of these patients are considered to be hemodynamically unstable condition, possible complications of the procedure to be applied, and selection of patients should be carefully evaluated.

Kidney and uro-trauma: WSES-AAST guidelines

“…No data exist regarding the best management strategy in low resource settings, although it seems rational to use OM in those circumstances. Low resource settings, in a limited sense, could be considered similar to military settings where lack of well-equipped hospital facilities, increased distance from trauma centers, and long transport time to definitive care facilities are the norm [167].…”

Analysis of battle and non-battle traumatic renal injuries: a 6-year experience in a conflict zone in Afghanistan

“…In the case of blast effects, the authors observed intraoperatively that the liver has a protective effect on the right kidney such that it may sustain the impact of the blast injury. In renal and liver injuries not directly attributable to projectile, although the blast effect caused higher-grade liver injuries, it was observed that a lower-grade right kidney injury occurred at the same time [11] Paquette presented results of a research in which, out of the 2712 trauma cases, 76 (2.8%) out of 98 cases had one or more genitourinary injuries. Out of the 29 kidney injuries, 2 were explored without any treatment, 7 were observed, 1was repaired and 19 casualties required nephrectomy [14].…”