Traumatic rupture of the kidney is an uncommon but not rare event. Its occurrence is estimated at one to every 1,000 to 3,000 injuries. The clinical picture is fairly characteristic, the main features being pain, tumor, hematuria, ecchymoses, shock. If a history of trauma is given, the diagnosis is usually not difficult. If, on the other hand, nothing is known about the trauma it is hard enough to recognize the condition. This occurred in a case recently observed. Case Report Mrs. E. F., a 51-year-old white woman, complained of acute, sharp, cutting pain radiating down the left thigh, accompanied by blood in the urine, nausea, and vomiting. Absolute bed rest failed to stop the bleeding and her physician referred her to the New Rochelle Hospital for further observation. The possibility of a renal tumor was considered most likely. Five days after admission the condition of the patient permitted cystoscopic examination. The bladder was found to be perfectly normal. Pure blood was seen coming from the left ureter. Indigo carmine injected intravenously appeared on the right side in 5 minutes and on the left in 10 minutes. A flat roentgenogram of the abdomen showed the shadow of the left kidney to be immensely enlarged, reaching from the 11th dorsal to the 4th lumbar vertebra. There was no evidence of any radio-opaque lithiasis which could have explained the bleeding. Intravenous pyelography tended to confirm the suspicion of a tumor of the left kidney. Only the upper calyx was filled by the contrast substance. A diffuse accumulation of dye was visible in the region of the upper part of the pelvis. The middle and lower parts of the pelvis and calyces were not filled at any time (Fig. 1). A retrograde pyelogram showed all the calyces to be well filled by the contrast substance, not widened, and not deflected from their normal place in the kidney. There was a fairly large distance between the upper calyx on the one hand and the middle and lower calyces on the other. This space. which should have been occupied by the kidney pelvis, showed only patchy accumulations of dye with very irregular outlines. The tip of the catheter was found to be outside of the calyces (Fig. 2). With these findings at hand, the idea of a neoplasm had to be abandoned. Enlargement of the kidney by a parenchymal tumor would have caused deflection of one or more of the calyces, while a hydronephrosis or pyonephrosis would have caused enlargement of the calyces. The presence of a rupture of the kidney was therefore suspected and on further questioning was confirmed, the patient admitting that she had slipped and fallen on the edge of the bath tub, striking her left flank. In view of the continuous bleeding, a nephrectomy was done. It was found that the left kidney, together with its capsule, was torn entirely in two parts, at the level of the hilum.
Read full abstract