CONSERVATIVE MANAGEMENT OF PENETRATING AND BLUNT TYPE-III RENAL INJURIES

Objective To determine the optimal management, conservative or surgica l, of patients with penetrating or blunt Type III renal injuries. Pati ents and methods This retrospective study comprised 122 patients with blunt abdominal or penetrating trauma with suspected significant renal injuries, Forty-five patients (32 penetrating and 13 blunt trauma) wi th Type III injury were identified. Of these patients, 28 (17 penetrat ing and 11 blunt trauma) had their renal injuries treated conservative ly while 14 patients, all with penetrating injuries, underwent immedia te surgical repair, Three patients died from multiple trauma shortly a fter arrival in the emergency room. Results In the 42 surviving patien ts with Type III renal injuries, four required delayed intervention. T hese included two of those managed conservatively and two of the 14 wh o underwent initial surgical intervention. Three renal units were lost , all of which were in those treated surgically, Thus, of the 42 survi ving patients with Type III renal trauma, 28 (67%) were successfully m anaged conservatively without renal loss. Conclusion This study sugges ts that Type III penetrating trauma may be successfully managed conser vatively with a similar outcome to those patients with Type III blunt injuries. Initial surgical intervention may only be necessary in those with associated intra-abdominal injuries or haemodynamic instability.