Management of High Grade Renal Trauma: 20-Year Experience at a Pediatric Level I Trauma Center

Henderson, Charmaine; Sedberry-Ross, Sherry; Pickard, Robert; Bulas, Dorothy; Duffy, Brian J.; Tsung, D.; Eichelberger, Martin R.; Belman, A. Barry; Rushton, H. Gil

doi:10.1016/j.juro.2007.03.048

Cited by 78 publications

(50 citation statements)

References 13 publications

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“…Fizyolojik parametrelerin takibini temel alan, gerekli radyoloji olanaklarıyla desteklenen, deneyimli bir cerrahi ekibi tarafından uygulanan KBY'nin ameliyatsız yöntemle tedavisi en az cerrahi tedavi kadar etkili ve başarılı olabilmektedir. [13][14][15] Ameliyatsız yöntem-le tedavi uygulanabildiği taktirde; anesteziye bağlı riskler ve olası komplikasyonlar, ameliyat sırasında iyatrojenik yaralanma riski, ameliyat sonrasında insizyonel herniasyon veya karıniçi yapışıklık riski, yüksek morbidite ve mortalite oranları, ameliyatın getirdiği yüksek maliyet, hastanede kalış ve işe dönüş sü-resinin daha uzun olması ve buna bağlı ekonomik kayıplar gibi ameliyatın getirdiği dezavantajlardan da kaçınılmış olunacaktır.…”

Section: Discussionunclassified

Blunt renal trauma in children: a retrospective analysis of 41 cases

Balcıoğlu¹,

Böleken²,

Cevik³

et al. 2014

Ulus Travma Acil Cerrahi Derg

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ÖZET AMAÇ: Çocukluk çağında, künt karın travma sonrası gelişen böbrek yaralanmaları ameliyatsız yöntemle başarıyla tedavi edilmektedir. Bu çalışmada, çocuklarda künt karın travmasına bağlı böbrek yaralanması olan olgular değerlendirildi. GEREÇ VE YÖNTEM:Bu çalışmada 2000 ile 2012 yılları arasında künt travmaya bağlı böbrek yaralanması nedeniyle çocuk cerrahi servisinde takip edilen olguların bilgileri geriye dönük olarak değerlendirildi. Olgular demografik özellikleri, klinik, tedavi ve sonuçları açısında değerlendirildiler. BULGULAR:Kırk bir olgu yatırıldı. Olguların yaş ortalaması 10±4.85 idi. Böbrek yaralanmalarının çoğu sınıf 1-2 idi. En sık böbrek yaralanma mekanizması düşmeydi. Bütün olgular başlangıçta konservatif takip edildi. Hemodinamik stabilitesi bozulan üç olgu (sınıf 4-5) ameliyata alındı. Pedikül yaralanmasından dolayı, üç olguya da nefrektomi yapıldı. SONUÇ:Çocuklarda böbrek parankim yaralanmalarında konservatif tedavi etkili ve güvenilirdir. Çoğu böbrek hasarı cerrahi gerektirmemesine rağmen, hasarın derecesine bakılmaksızın hayatı tehdit eden kanamalara cerrahi girişim yapılmadır.

show abstract

Section: Discussionunclassified

Blunt renal trauma in children: a retrospective analysis of 41 cases

Balcıoğlu¹,

Böleken²,

Cevik³

et al. 2014

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

show abstract

“…There are no prospective data comparing the hospital location to which the child should be admitted. Further, a majority of the series published fail to address the admission level of care [2,55,59,65,67,68,70,73,[75][76][77][78][79][80][81][82][83][84][85][86][87]. When addressed, the general opinion is to admit pediatric patients with renal injuries to the ICU for observation.…”

Section: Intensive Care Unit Observationmentioning

confidence: 99%

“…The exact incidence is difficult to define since no study has encompassed the entire denominator of patients with renal injury and captured comprehensive follow-up for those patients. Estimates have placed the incidence between 0 and 7.5% [24,57,62,63,66,68,72,73,79,81,94]. Clearly, hypertension can occur after renal injury, but the incidence is limited by several factors.…”

Section: Hypertensionmentioning

confidence: 99%

Review of the evidence on the management of blunt renal trauma in pediatric patients

et al. 2009

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Due to the size and location within the pediatric patient, the kidneys are susceptible to injury from blunt trauma. While it is clear that the goal of management of blunt renal trauma in children is renal preservation, the methods of achieving this goal have not been well established in the current literature. Therefore, we have set out to summarize and clarify the current published information on the management strategies for blunt renal trauma in children. While there is extensive literature available, it consists mostly of retrospective series documenting widely varied management styles. The purpose of this review is to display the current information available and delineate the role for future studies that may allow us to develop consistent management strategies of pediatric patients, who have sustained blunt renal trauma, in a safe and cost-effective manner.

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“…Several reports have found that surgery is required only when a child is hemodynamically unstable or has major associated injuries, or when one kidney is not visible on a contrast-enhanced CT scan. [2][3][4] Internal stenting with or without percutaneous drainage is indicated if there is progressive urinoma or persistent urinary extravasation. Complete parenchymal fracture or significant urine extravasation may be less likely to resolve spontaneously; however, a CT scan with three-dimensional reconstruction may show a pre-existing anatomic abnormality, which may influence the decision for surgery.…”

mentioning

confidence: 99%

Anatomic anomaly in renal blunt trauma

Wu¹,

Huang²,

Kuo³

et al. 2010

Canadian Medical Association Journal

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A nine-year-old girl with cerebral palsy presented with pain in her left flank and gross hematuria that occurred 24 hours after a fall against a chest of drawers. She was alert, and her temperature was 39.2°C, heart rate 155 beats/min and blood pressure 95/62 mm Hg. Her conjunctivae were pale, and there was tenderness to percussion over the left costovertebral angle. No bruise or wound was seen. Complete blood count showed mild leukocytosis and a hemoglobin level of 90 (normal 120-140) g/L. Other laboratory data, including coagulation profile and renal function, were normal. Blunt injury of the left kidney was diagnosed. Volume expansion with normal saline and two units of packed red blood cells was started immediately.A contrast-enhanced computed tomography (CT) scan showed a deep, full-thickness parenchymal fracture extending to the pelvis of the patient's left kidney, with minimal urine extravasation (Figure 1). The renal injury was compatible with a grade 4 injury, as defined by the Renal Injury Scale of the American Association of Surgeons in Trauma.1 However, the disparity between the deep laceration into the pelvis and minimal urine extravasation implied pre-existing duplicated collecting systems, which were confirmed by CT scanning with three-dimensional reconstruction. Two days after complete bed rest and supportive treatment, the gross hematuria subsided, and the flank pain disappeared. After 18 days in hospital, the girl was discharged home. She will require longterm follow-up, because she is at increased risk of posttraumatic renal hypertension.Our case supports conservative management of high-grade renal blunt injury (grades 3 to 5) in children. Several reports have found that surgery is required only when a child is hemodynamically unstable or has major associated injuries, or when one kidney is not visible on a contrast-enhanced CT scan.2-4 Internal stenting with or without percutaneous drainage is indicated if there is progressive urinoma or persistent urinary extravasation. Complete parenchymal fracture or significant urine extravasation may be less likely to resolve spontaneously; however, a CT scan with three-dimensional reconstruction may show a pre-existing anatomic abnormality, which may influence the decision for surgery. 5 This article has been peer reviewed.Competing interests: None declared.

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Management of High Grade Renal Trauma: 20-Year Experience at a Pediatric Level I Trauma Center

Cited by 78 publications

References 13 publications

Blunt renal trauma in children: a retrospective analysis of 41 cases

Blunt renal trauma in children: a retrospective analysis of 41 cases

Review of the evidence on the management of blunt renal trauma in pediatric patients

Anatomic anomaly in renal blunt trauma

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