title: Major blunt renal trauma in the pediatric population: is a nonoperative approach indicated?
abstract: We evaluated and treated at our institutions 22 consecutive patients with major blunt renal trauma: 20 had major renal lacerations (grades 3 to 5) as defined by initial computerized tomography, and 2 had vascular pedicle injuries without parenchymal injury and were excluded. An attempt was made to treat all children with a nonoperative approach. Two patients (10%) required renal exploration: 1 for persistent bleeding and 1 in whom a renal neoplasm could not be excluded. The remaining 18 patients (90%) were stabilized and observed. No child required delayed renal exploration. All traumatized renal units demonstrated function on followup studies. Hypertension did not occur in the 13 patients available for long-term followup. We conclude that nonoperative management is a suitable alternative to early exploration in children with major blunt renal lacerations.
authors.affiliation: Department of Urology, Rainbow Babies and Children's Hospital, Cleveland, Ohio.
authors.forename: E M
authors.initials: EM
authors.lastname: Smith
authors.forename: J S
authors.initials: JS
authors.lastname: Elder
authors.forename: J P
authors.initials: JP
authors.lastname: Spirnak
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000293:injuries*; D008297:Male; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000628:therapy*