Percutaneous transcatheter super-selective embolization of a tributary of an accessory renal artery to control traumatic haematuria from a horseshoe kidney-a case report

Abstract

Objectives: The most experienced clinicians could easily miss serious renal injury at surgery. We report a case of a recently diagnosed bleeding from a lacerated horseshoe kidney with a review of the literature. Methods: The clinical and imaging records and laboratory results of a patient with blunt abdominal trauma were reviewed who initially underwent splenectomy for splenic injury, but a renal injury was missed at laparotomy. We also carried out a review of published reports of renal artery injuries. Results: A thirty-year-old man was admitted as an emergency to a hospital after he had sustained blunt abdominal trauma in a go-carting accident. He underwent splenectomy for splenic injury following which he was discharged. A few days later, he was seen in another hospital complaining of left loin pain where, a provisional diagnosis of urinary tract infection and possible haematoma around his splenic bed was made. He discharged himself against medical advice before further imaging could be undertaken. He presented to a third hospital with abdominal pain and then developed haematuria severe enough for him to be transfused. Ultra-sound scan and CT-scan of the abdomen and pelvis showed injury to a horseshoe kidney with haematoma which was initially drained percutaneously. Post contrast axial CT scans showing the transacted kidney and active renal bleeding are shown in Figures 1 & 2. A selective renal artery angiogram confirmed bleeding from a tributary of an accessory descending left renal artery that was successfully treated by super-selective embolization (Figures 3, 4, 5 and post embolization CT Figure 6). Conclusions: Ultrasonography and Computed Tomography are instrumental in the diagnosis of a horseshoe kidney. Both ultrasound and CT scans confirm a renal/peri-renal haematoma resulting from renal trauma. Selective renal artery angiography not only confirms the source of bleeding but also allows superselective arterial embolization as a definite or stopgap treatment.Super-selective embolization of renal haemorrhage is comparatively non-invasive and preferred to open surgery.