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RENAL TRAUMA

RENAL TRAUMA. Dr. Abdullah Ghazi Ass. Consultant PMAH 13/2/2014. INTRODUCTION. 10% of trauma involve genitourinary tract. 2% of them (solitary GU injury). Kidney is the most common injured organ. RENAL INJURY. Blunt: MVA. Fall down Deceleration → vascular injury Penetrating: Gunshot

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RENAL TRAUMA

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  1. RENAL TRAUMA Dr. Abdullah Ghazi Ass. Consultant PMAH 13/2/2014

  2. INTRODUCTION 10% of trauma involve genitourinary tract. 2% of them (solitary GU injury). Kidney is the most common injured organ.

  3. RENAL INJURY • Blunt: • MVA. • Fall down • Deceleration → vascular injury • Penetrating: • Gunshot • Stab wound

  4. RENAL INJURY • Renal injury suspected: • Stab wound at upper abdomen, lower chest or flank. • # lower rids, thoracic vertebra or upper lumber. • Note: • Gunshot is misleading. • Hematuria, (best indicator, not correlate with severity)

  5. RENAL INJURY • Evaluation: • Hx: • Mechanism of trauma • Loss of consciousness • Hematuria • Voiding after trauma • Flank or supra-pubic pain • Previous GU anomalies

  6. RENAL INJURY • Evaluation: • Ex: • Vital sign • Abd: bruises, wound, distension, masses, tenderness • Genitalia: peruses, wound, blood at the meatus • DRE: high riding prostate

  7. RENAL INJURYRADILOGY • Enhanced CT-scan • Indication: • Gross Hematuria • Mic. Hematuria + shock SBP<90 • Hx, Ex, suspecting. • Note: children have more risk of injury.

  8. RENAL INJURYRADILOGY • CT finding suggest major injury: • Medial hematoma. • Medial urine extravasations. • Lack of parenchymal enhancement. • Disadvantage: ? Venus injury.

  9. RENAL INJURYCLASSIFICATION

  10. RENAL INJURYCLASSIFICATION

  11. RENAL INJURYMANAGEMENT • 86% manage conservatively. • Restricted bed rest • IVF • NPO (? OR) • Hgb q8hr • ? Abx

  12. BLUNT RENAL INJURYMANAGEMENT 89% of renal blunt trauma can managed conservatively Hotaling JM, J Urol. 2012 Feb 71% of Grade V need surgical management. Thanapaisal C, 2013 Sep

  13. PENETRATING RENAL INJURYMANAGEMENT Grade IV need immediate repair Minor degree of injury (penetrating, gunshot), posterior to anterior auxiliary line can managed conservatively.

  14. In case of failed conservative management: • Angioembolization:

  15. RENAL INJURYMANAGEMENT • Absolute indication of operation: • Persistent renal bleeding. • Expanding perirenal hematoma. • Pulsatile perirenal hematoma.

  16. RENAL INJURYMANAGEMENT • Relative indication of operation: • Urinary extravasation. • Nonviable tissue >20%. • Delay Dx of arterial injury. • Segmental arterial injury.

  17. Renal Injury • In case of unstable patient: • Immediate exploration • One-shot intraoperative IVP can be done (2mg/kg)

  18. RENAL INJURYOPERTATIVE TECHNIQUE

  19. RENAL INJURYMANAGEMENT • Renal reconstruction principle:

  20. RENAL INJURYNOTE • Renovascular injury:. • Clamp the pedicel, suture. • Dx >8hrs, kidney cannot be salvaged. • >20% non-viable tissue → exploration • Damage control: laparatomy pads & re-open after 24hrs. • ?? Life → Nephrectomy

  21. RENAL INJURYCOMPLICATION Persistent urinary extravasation, perinephric infection, renal loss. Delayed bleeding 21D. Perinephric abscess HTN

  22. Follow Up • Low grade injury • U/S • High grade injury: • CT scan after 48-72 hrs • CT scan after 3 months • ?? DMSA

  23. Thank You For Your Attention

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