Multiple abdominal trauma and evolution in treatment of renal trauma 4-5 grade

Abstract

Introduction. Blunt renal trauma is the most common urologic disturbance. For the last 2 decades, the number of renal trauma decreases: from 1-8% to 0,4%-1,07%. Men are more vulnerable than women. Usually patients are of working age and the trauma is caused with traffic accident or fall from a height. In cases of 4-5th grade of renal trauma (according OIS classification) multiple abdominal organ`s disturbances are revealed in 64,3-90,6% patients. It leads to the fact that surgery is often performed by abdominal surgeon holding another operative opinion than urologist. Nowadays, expectant approach in 1-3 OIS grade of renal trauma is common. On the other hand, no consensus is achieved in treatment strategy of 4-5 OIS grade patients. Purpose of the work: to determine the frequency of kidney injury in patients with closed abdominal trauma, to identify patients with severe injuries among patients with kidney injury, to compare the treatment tactics of this category of patients before and after the appearance of the urological service at the N.V. Sklifosovsky Institution. Material and methods. Retrospective study of 187 patients with blunt abdominal trauma was performed during the period of 2016-2019. In 32,6% cases multiple disturbance including kidney was detected. Male persons were more common (73,8%), age 18-72 (37,9±8,83), usually suffered road traffic accident (57,4%) or height fall (31,1%). Stable patients (ISS<16) were 67,2%, unstable (ISS≥16) – 32,8%. The severity of renal disturbance was appreciated with CT in 67,2% case and after laparotomy in others. Treatment strategy was defined by urologists in 5 patients with OIS grade 3-5 and by general surgeons in 15 patients. Results. In «urology» group laparotomy and renal exploration was done in 1(20%) person, embolization of renal artery branch was performed in 2(40%) and non-operative management was chosen for 2(40,0%) patients with sufficient outcome. Hospital stay amounted to 13,7±2,4 days. All patients of «general surgery» group underwent laparotomy. Among them paranephric hematoma was explored in 2(13,4%), nephrorrhaphy was done in 3(20,0%) and nephrectomy – in 10(66.6%) injured ones. Hospital discharge on 17,5±3,5 day. Discussion. All patients with renal trauma met abdominal organs disturbances too. Urologists in these cases are more prone to expectant strategy than general surgeons while less aggressive (expectant and angiosurgery) approach demonstrates better outcomes. Conclusion. In case of similar grade of renal trauma expectant approach and angioembolisation save the patient from open surgery in 80% cases, facilitates early activation and shorten hospital stay significantly. In view of paucity of such cases in our review following studies are expected.