Selective surgical management of renal stab wounds.
Patients with stab wounds and haematuria were selected for surgical exploration if they had signs of severe blood loss, an associated intra-abdominal laceration or major abnormality on the intravenous urogram (IVU). Patients without these signs were selected for non-operative management, consisting of bed rest, an intravenous antibiotic for 24 h and regular observation. Of 95 patients, 60 (63%) were selected for non-operative management (Group 1) and 35 (37%) were selected for primary surgical exploration (Group 2). At surgery in Group 2, a major renal injury and/or associated intra-abdominal laceration was found in 31 patients. Thus a probably unnecessary operation was performed in only 4 patients (4% of the whole group of 95 patients). Renal complications occurred in 12 of the 60 patients (20%) in Group 1 and consisted mainly of secondary haemorrhage caused by an arteriovenous fistula (AVF) or pseudo-aneurysm. Management of the renal complications included segmental artery embolisation in 6, nephrectomy in 2, heminephrectomy in 1, open surgical ligation of an AVF in 1 and spontaneous resolution in 2 patients. The mean period of hospitalisation was significantly shorter in Group 1 (6.1 days) than in Group 2 patients (9.9 days). Comparing the Group 1 patients who developed renal complications with those who did not, we would recommend more aggressive selection for surgery of those patients exhibiting clinical signs of shock, a fall in haemoglobin during observation, a palpable abdominal mass, a haemothorax and/or pneumothorax ipsilateral to the renal injury, and IVU signs of extravasation, non-function, delayed excretion or hydroureteronephrosis due to blood clots.(ABSTRACT TRUNCATED AT 250 WORDS)
Heyns
C F
CF
Department of Urology, Tygerberg Hospital, South Africa.
Van Vollenhoven
P
P
D000293:Adolescent; D000328:Adult; D004621:Embolization, Therapeutic; D005260:Female; D006417:Hematuria / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011183:Postoperative Complications / Q000209:etiology; D011859:Radiography; D014951:Wounds, Stab / Q000601:surgery*