Blunt Renal Trauma in Children with the Prune-Belly Syndrome

Abstract

We report significant blunt renal injury resulting from 3 traumatic events in 2 boys with the prune-belly syndrome. Manifestations of the syndrome influenced the clinical and radiographic assessment of the urinary tract injuries. Nonoperative management resulted in excellent outcomes without long-term sequelae.

Review of the evidence on the management of blunt renal trauma in pediatric patients

“…There are no prospective data comparing the hospital location to which the child should be admitted. Further, a majority of the series published fail to address the admission level of care [2,55,59,65,67,68,70,73,[75][76][77][78][79][80][81][82][83][84][85][86][87]. When addressed, the general opinion is to admit pediatric patients with renal injuries to the ICU for observation.…”

“…There are inconsistent reports on the use of antibiotics, but most series do not address this point. Some authors simply mention the use of antibiotics, void of type and duration [9,61,64,67,73,78,81]. One series of patients with major renal injuries describes prophylactic antibiotics, but there is no indication when therapy should cease [77].…”

“…More recent studies report utilizing strict bed rest, but do not detail the length of time nor criteria for mobilization. [9,61,78,80,87] Several authors have recommended bed rest until hematuria clears [66,67,72,76,85]. However, such criteria can lead to prolonged periods of bed rest and consequently inflated length of hospitalization.…”