Oncethe decision to operate the wounded patient hasbeen reached, several surgical options are thenavailable. One of these, which should be consideredfor restoring renal blood flow in left sided injuries, is toperform a splenorenal bypass with or withoutsplenectomy.Case ReportA 9-year-old boy was admitted to the emergency roomfollowing a head-on motor vehicle accident in whichhe was a restrained passenger. On arrival, the primaryassessment of the patient was normal. The patientcomplained of severe abdominal and left chest pain.His physical examination findings were a seat belt signacross his abdomen, moderate abdominal distensionwith diffuse tenderness on palpation. The patienthad microscopic haematuria and the serum creatininewas 0.7 mg/dl. Chest radiograph was normal. Anultrasound examination performed in the shock roomrevealed intra-abdominal fluid. Following these find-ings, and since the patient was haemodynamicallystable, we elected to further evaluate his injuries by anabdominal contrast enhanced CTS. The CTS demon-strated a grade IV splenic laceration, and the leftkidney showed no nephrographic effect. During theCTS, the patient became haemodynamically unstablewith systolic blood pressure dropping to below60 mmHg. Therefore, the patient was taken promptlyinto surgery. After evacuation of blood from theabdominal cavity, a severely injured spleen wasnoted and removed. Following colonic mobilizationand upon achieving renal vascular control the leftkidney was exposed, and was found to be ischemicwith renal artery thrombosis. At this point, the patientmaintained vital signs within the normal range, and itwas decided to revascularize the kidney. The splenicartery was dissected free along its course. Fogartythrombectomy of the distal renal artery was carriedout and an end-to-end anastomosis between thesplenic artery and the distal renal artery wasperformed. Upon completion of the procedure thekidney regained a normal colour and there was a goodquality Doppler signal at the renal hilum. One monthafter discharge a follow-up CTS was carried out. Theleft kidney was functioning but had a slightly delayedexcretion. In the following year the patient becamehypertensive. CTS demonstrated a shrinked, poorlyfunctioning kidney. The patient maintains a normal
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