Presentation
Came off bike downhill.
Patient Data
There is complete separation of the upper and lower half of the right kidney by approximately 6cm. The fracture extends through the right renal pelvis. A large peri- and para-nephric hematoma on the right extends to the anterior mesentery, perihepatic, right paracolic gutter and to the pelvis. Contrast is seen in the proximal right renal vein which then fades off hence suggesting transection at this site. The ascending colon is displaced medially. There is good enhancement of the upper and lower right renal poles. Appearances are consistent with a grade 5 American Association for the Surgery of Trauma (AAST) injury to the right kidney.
Normal appearances of the liver, gallbladder, spleen, pancreas, adrenals and left kidney. No bone fracture within the region scanned.
CT Chest (not included above was normal).
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- Note good renal cortical enhancement which suggests arterial perfusion.
- Complete separation of the upper and lower renal pole.
- Site of right renal vein transection (arrow).
Case Discussion
Most grade I to IV injuries can be treated conservatively, thus avoiding unnecessary surgery.
Surgery is indicated for :
- vascular (renal pedicle) injury
- shattered kidney
- expanding or pulsatile hematoma
- shocked polytrauma patient
Our case was reviewed by the local trauma unit. The plan was for conservative management as the patient was haemodynamically stable.
Case contributed by Dr A Kraus.
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