MAJOR RENAL LACERATIONS WITH A DEVITALIZED FRAGMENT FOLLOWING BLUNT ABDOMINAL-TRAUMA - A COMPARISON BETWEEN NONOPERATIVE (EXPECTANT) VERSUSSURGICAL-MANAGEMENT

Of 43 patients who sustained blunt trauma resulting in a major renal l aceration with a devitalized fragment 27 had coexisting intraperitonea l and renal injuries for which emergency celiotomy and repair of the n onurological trauma were done. Management of the renal injuries consis ted of simultaneous renal exploration with 23% urological morbidity in 13 cases or expectant management with 85% urological morbidity in 14 cases. In this latter patient population infected urinomas and perinep hric abscesses seeded from coexisting enteric or pancreatic injuries w ere the most common complication (57%). The remaining 16 of the 43 pat ients sustained renal lacerations without associated intraperitoneal i njuries and all were managed expectantly with 38% urological morbidity . These findings suggest that renal exploration and surgical repair si gnificantly improve the prognosis only in patients with simultaneous i ntraperitoneal and renal injuries (p <0.01).