High grade renal injury due to multitrauma: Emergency service and non-operative management

Öz

Trauma is a global problem. Interventions must be effective and efficient in terms of resource utilization. False negative findings or delayed diagnoses carry the risk of serious complications. Although the retroperitoneal location of the kidney provides some protection, the kidney is the most commonly injured genitourinary organ. Recently, with advances in imaging, nonsurgical treatment has become more common. However, emergency nephrectomy remains the gold standard treatment for acute uncontrolled renal hemorrhage. In this case, we present the emergency department and nonsurgical treatment of a multiple trauma patient with grade 4 renal injury resulting from gunshot wound. We also compare Whole Body Computed Tomography with Selected Computed Tomography.

Anahtar Kelimeler

• Trauma
• Emergency Treatment
• Computerised Tomography
• Kidney injury
• Conservative Treatment

Multitravma sonucu yüksek gradeli renal yaralanma: Acil servis ve nonoperatif yönetimi

Öz

Travma küresel bir problemdir. Müdahaleler kaynak kullanımı açısından etkili ve verimli olmalıdır. Yanlış negatif bulgular veya gecikmiş tanılar ciddi komplikasyon riski taşır. Böbreğin retroperitoneal konumu bir miktar koruma sağlasa da böbrek en çok yaralanan genitoüriner organdır. Son zamanlarda, görüntülemedeki gelişmelerle birlikte, cerrahi olmayan tedavi daha yaygın hale gelmiştir. Ancak, acil nefrektomi, akut kontrol edilemeyen böbrek kanaması için altın standart tedavi olmaya devam etmektedir. Bu olgumuzda silahla yaralanma sonucu oluşan 4. derece böbrek yaralanması olan çoklu travma hastasının acil servis yönetimi ve cerrahi müdahale gerektirmeyen tedavisini sunuyoruz. Ayrıca bu vakada Tüm Vücut Bilgisayarlı Tomografi ile Seçilmiş Bilgisayarlı Tomografi’nin bu olgudaki etkinliklerini karşılaştırmaktayız.

Anahtar Kelimeler

• Travma
• Acil Tedavi
• Bilgisayarlı Tomografi
• Böbrek hasarı
• Konservatif Tedavi

Kaynakça

1. 1. Nishijima DK, Simel DL, Wisner DH, Holmes JF. Does this adult patient have a blunt intraabdominal injury? JAMA. 2012;307(14):1517–27.
2. 2. McClung CD, Hotaling JM, Wang J, Wessells H, Voelzke BB. Contemporary trends in the immediate surgical management of renal trauma using a national database. Journal of Trauma and Acute Care Surgery. 2013;75(4):602–6.
3. 3. Martínez-Piñeiro L, Djakovic N, Plas E, Mor Y, Santucci RA, Serafetinidis E, et al. EAU Guidelines on Urethral Trauma. Eur Urol. 2010;57(5):791–803.
4. 4. Xie J, Liu Y, Chen T, Xiao KF. Case report of bilateral penetrating renal trauma caused by a wooden stick. Medicine (United States). 2020;99(16).
5. 5. Erlich T, Kitrey ND. Renal trauma: the current best practice. Ther Adv Urol. 2018;10(10):295–303.
6. 6. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet. 2012;380(9859):2095–128.
7. 7. Schoeneberg C, Schilling M, Burggraf M, Fochtmann U, Lendemans S. Reduction in mortality in severely injured patients following the introduction of the “treatment of patients with severe and multiple injuries” guideline of the German society of trauma surgery – a retrospective analysis of a level 1 trauma center (2010–2012). Injury. 2014;45(3):635–8.
8. 8. Shannon L, Peachey T, Skipper N, Adiotomre E, Chopra A, Marappan B, et al. Comparison of clinically suspected injuries with injuries detected at whole-body CT in suspected multi-trauma victims. Clin Radiol. 2015;70(11):1205–11.

9. 9. Huber-Wagner S, Lefering R, Qvick LM, Körner M, Kay M V, Pfeifer KJ, et al. Effect of wholebody CT during trauma resuscitation on survival: a retrospective, multicentre study. The Lancet. 2009;373(9673):1455–61.
10. 10. Huber-Wagner S, Biberthaler P, Häberle S, Wierer M, Dobritz M, Rummeny E, et al. Whole-Body CT in Haemodynamically Unstable Severely Injured Patients – A Retrospective, Multicentre Study. PLoS One. 2013;8(7):e68880.
11. 11. Colaco M, Navarrete RA, MacDonald SM, Stitzel JD, Terlecki RP. Nationwide Procedural Trends for Renal Trauma Management. Ann Surg. 2019;269(2):367–9.
12. 12. Mingoli A, La Torre M, Migliori E, Cirillo B, Zambon M, Sapienza P, et al. Operative and nonoperative management for renal trauma: comparison of outcomes. A systematic review and meta-analysis. Ther Clin Risk Manag. 2017;13:1127–38.
13. 13. Hampson LA, Radadia KD, Odisho AY, McAninch JW, Breyer BN. Conservative Management of High-grade Renal Trauma Does Not Lead to Prolonged Hospital Stay. Urology. 2018;115:92–5.