CASI CLINICI   

Chirurgia 2014 August;27(4):233-5

Copyright © 2014 EDIZIONI MINERVA MEDICA

lingua: Inglese

Conservative treatment for massive fracture of the kidney after trauma

Magistri P., Sirimarco D., Amato S., D’Angelo F., Nigri G., Ramacciato G.

Department of Surgery, Sant’Andrea Hospital, La Sapienza University of Rome, Rome, Italy

The kidney is often involved after abdominal trauma and the management of renal injuries can be either surgical or conservative. We report the case of a 45 year old man admitted to the hospital after a trauma. Blood test demonstrated hemoglobin 13.6 g/dL, white blood cells 15.05x103/uL, INR 1.06. A CT scan was performed showing a large hematoma of the left kidney measuring 10x15 cm and multiple ribs fractures. Since he was conscious and hemodinamically stable, he was taken to the interventional radiology suite where a transartherial embolization was performed. Left kidney arteries were identified showing an active bleeding of three sub-segmental vessels of middle third of the left kidney. They were selectively catheterized and a compressive dressing was also applied. One week later a further CT control showed an organized hematoma, without active bleeding, neither contrast leakage, and regular urine flow through the left ureter. At that point blood tests showed hemoglobin 10.1 g/dL, white blood cells 10x103/uL, Creatininemia 0.8 mg/dL, Bun 14 mg/dL. The patient was finally discharged in good condition, tolerating a diet, without any sign of renal failure and normal range blood test.