Renal artery occlusion in pediatric blunt abdominal trauma--decreasing the delay from injury to treatment.
The cases of seven children treated from 1980 through 1991 with blunt renal artery injuries were reviewed to determine (1) if computed tomography alone could eliminate the need for intravenous pyelography (IVP) or arteriography (ART); and (2) the causes of management delays. The diagnosis of arterial occlusion was suggested by the lack of renal contrast enhancement in six patients with CT scans and in two patients with IVP. In three patients ART was merely confirmatory. The diagnosis was suggested by IVP or CT scan within a mean of 4.7 hours of injury, but ART added an additional mean 2.3 hours to the diagnostic workup. There was an additional 3.9-hour average delay in the operating room before revascularization. Six patients underwent revascularization. Four had minimal function by postoperative renal scans. Renal artery occlusion is rapidly detected by contrast-enhanced CT scanning without IVP or ART. The time period from diagnosis to revascularization must be expedited to improve renal outcome.
Smith
S D
SD
Department of Surgery, University of Pittsburgh School of Medicine, PA.
Gardner
M J
MJ
Rowe
M I
MI
D000792:Angiography; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D017598:Efficiency, Organizational; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007668:Kidney / Q000293:injuries*; D008297:Male; D017063:Outcome Assessment, Health Care; D010414:Pennsylvania; D011856:Radiographic Image Enhancement; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D015424:Reperfusion / Q000379:methods*; D012189:Retrospective Studies; D013996:Time and Motion Studies; D014057:Tomography, X-Ray Computed; D014194:Traumatology; D014567:Urography; D014949:Wounds, Nonpenetrating / Q000150:complications*