Management of severe blunt renal trauma in children

Abstract

Objective To study the management of severe blunt renal trauma in children. Methods From 2000 to 2008, clinical outcomes of 33 children with blunt renal trauma were retrospectively analyzed, especially focusing on the 15 severe blunt renal trauma cases (3 cases were hydronephrosis complicating with renal trauma).Results Neither deaths nor early nephrectomy was noted in this study. Eighteen patients with mild renal injury were cured after non operative management. Of the 15 severe cases, 8 were cured after conservative treatment, 3 with active bleeding were treated by selective renal artery embolization, and 1 with renal vascular injury underwent exploratory surgery and surgical repair of renovascular trauma; the other 3 were hydronephrosis complicating with renal trauma, of which 2 underwent pyloplasty and early postoperative drainage, and the last patient with renal failure and contralateral congenital renal atrophy underwent early post-injury nephrostomy and delayed pyloplasty to conserve more renal function. All severe cases have been followed-up for 5-28 months (mean follow-up duration: 18 months). One patient underwent nephrectomy of the atrophic kidney 6 months later for persistent secondary hypertension. Of the 4 cases complicated with urinary cysts, 1 underwent early ureteropelvic anastomosis, the other 3 underwent delayed urinary cysts resection.Conclusions Mild renal injury has a good prognosis after conservative treatment. The management of severe renal trauma should be based on specific clinical conditions of individuals. Early exploratory surgery and nephrectomy are not advocated on most severe renal trauma cases. The selective renal artery hemostatic embolization is a good option to stop active bleeding in blunt renal trauma patients. The severe renal trauma patients need close interval postoperative follow-up to prevent the complications such as urinary cyst and secondary hypertension. Key words: Renal trauma; Treatment; Children