Investigation and management of blunt renal injuries in children: a review of 11 years' experience.
Over an 11-year period, 333 patients aged 6 months to 13 years were investigated for suspected blunt renal trauma. Ninety-one renal injuries were demonstrated. All patients who had preexisting pathology sustained major (ie, grade III or IV) injuries and all those who required surgery presented with 4+ or macroscopic hematuria with or without loin signs. Intravenous pyelography (IVP) showed no injury in 140 (89%) of 157 patients who had 0 to 3+ microscopic hematuria, and did not influence management in the remaining 17 patients. Seventy-eight (84%) patients were treated nonoperatively, with one death and few complications. Thirteen (14%) patients underwent early laparotomy, with a nephrectomy rate of 92%. No patient with a renal pedicle injury was considered suitable for vascular reconstruction. We conclude that (1) contrast studies are of little value in pediatric patients with asymptomatic microscopic hematuria after blunt trauma; (2) IVP remains the most cost-effective means of investigating renal injuries; and (3) laparotomy is only indicated for ongoing hemorrhage from the severely injured kidney and in a few selected patients with renal pedicle injuries.
Bass
D H
DH
Trauma Unit, University of Cape Town, South Africa.
Semple
P L
PL
Cywes
S
S
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D007223:Infant; D007668:Kidney / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D009392:Nephrectomy; D014567:Urography; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000601:surgery / Q000628:therapy