Presentation on theme: "Renal Trauma Dr. Mohammad Amin K Mirza Presented By"— Presentation transcript:
1 Renal Trauma Dr. Mohammad Amin K Mirza Presented By Saudi Board of General Surgery, R5Al-Noor Specialist hospitalHoly Makkah– K.S.AMay 2008
2 Background The Kidney: Urologic injuries are rarely life-threatening, The kidney is the most commonly injured structure in the urinary tract, accounting for 1 percent of all traumatic injuries.only approximately 10 percent of renal injuries needed surgical interventionThe Kidney:Along T10 - L4Ribs 10-12Fixed only through pedicle.1.2L of blood / min
3 Blunt trauma Blunt trauma: 80-90% Caused by direct blow to the abdomen Acceleration – deceleration injury in fall downIndirect injury is much less commonInjury to the renal pedicle in 85 %of cases 90 per cent of these occur in patients under 25 years of age.The artery is injured in 70 %of patients,The vein in 20 %Both vessels in the remaining 10 %The mortality rate approaches 50 %, due mainly to the severity of associated injuries.
4 Penetrating injury90 % of gunshot wounds and 60 % of stab wounds to the kidney are associated with intra-abdominal injuries.
12 When to suspect renal injury Trauma to back / flank / lower thorax / upper abdomenFlank pain / low rib #Hematuria / Ecchymosis over the flanksSudden decelaration / Fall from height.Lumbar transverse process #
13 Lumbar Transverse Process Fractures Prospective study ( )Lumbar spine #191 patientsTransverse # in 29%Abdominal organ injuries 47%Kidney: 1/3Liver: 1/3Spleen: 1/4Miller et al. Lumbar transverse process fractures: a sentinel marker of abdominal organ injuries. Injury. 31:773; 2000.
28 Organ Injury Severity Scale Validated lately: Journal of Trauma, 2001Predicts the need for surgeryNeed for surgery ; nephrectomy rates:Grade I: ; 0%Grade II: 15 ; 0%Grade III: 76 ; 3%Grade IV: 78 ; 9%Grade V: 93 ; 86%Santucci et al. Validation of the American Association for the Surgery of Trauma Organ Injury Severity Scale for the Kidney. J Trauma; 50: ; 2001.
32 Conservative management - 50 % of all penetrating renal injuries and fewer than 5% of bluntinjuries necessitate operative management.All grade I and II renal injuries, regardless of the mechanism of injury, can be managed with observation alone because the risk of delayed bleeding is extremely low.Most grade III and IV injuries, including those with devitalized parenchymal fragments and urinary extravasation, can be managed nonoperatively with close monitoring, serial hematocrit measurement, and repeat imaging in selected cases.Active arterial bleeding, in the absence of other associated injuries, can be treated with emergency arteriography and angioembolization.Thrombosis of the renal artery or its branches is treated expectantly unless the contralateral kidney is absent or injured, in which case emergency revascularization is indicated.Endoluminal stenting and thrombolytic therapy is a promising
33 Management in summery Absolute indication for Surgery: Grade I-II Uncontrollable renal hemorrageMultiply lacerated, shattered kidneyMain renal vessels avulsedPenetrating injuries usuallyGrade I-IIconservativeGrade III-IVConservative if stable hemodynamically vs. surgeryGrade VSurgery