MANAGEMENT OF RENAL TRAUMA AT A RURAL, LEVEL-I TRAUMA CENTER

Appropriate management of renal trauma is controversial. Successful ou tcome and long term complication rates are not well defined. IN an eff ort to evaluate management options, outcomes, and complications of ren al injuries, we conducted a retrospective review of all trauma patient s admitted to the trauma service from January 7, 1989 through August 3 1, 1995. Inpatient and outpatient charts were reviewed for type and me chanism of injury, radiologic studies utilized, method of treatment, a nd short and long term complications. Fifty-five patients were identif ied with renal injuries. Most injuries were parenchymal injuries due t o blunt trauma. Only nine patients with renal artery injuries and four patients with collecting system injuries were identified. CT scan was the most commonly used study to identify renal injuries. All nine ren al artery injuries were due to blunt trauma and were initially diagnos ed by CT scan. Six were confirmed with arteriogram, and two with renal scans. Of the seven patients seen in follow-up (average 153 days), th ere were three complications: one patient with small bowel obstruction and two patients with hypertension. Among the 47 patients with parenc hymal injuries, including 4 patients with collecting system injuries, there were 2 with complications: an intraoperative ureteral transectio n and a urinoma. Both complications were treated successfully with a u reteral stent. Five deaths occurred in the entire group; none were rel ated to renal injury. Thirteen patients underwent laparotomy for assoc iated injuries only. Eight patients underwent surgical treatment for t heir renal injury, including five nephrectomies. The nephrectomy rate among those patients who underwent laparotomy as part of their initial management was 20 per cent, versus 3 per cent for those patients init ially managed nonoperatively. Thus, most renal injuries can be managed nonoperatively with a low incidence of complications. The incidence o f long-term complications after renal artery injuries and the appropri ate management of these patients deserves further study.