[Trauma of the renal pedicle in children. Report of 2 cases of late revascularization with endovascular prosthesis].
OBJECTIVE
The diagnosis of renal pedicle rupture in children is difficult and often delayed. Ultrasound alone is insufficient in the assessment of all cases of renal contusion. This often leads to nephrectomy, due to the uncertain results of a late surgical revascularization procedure. A minimally invasive endovascular approach is therefore sometimes useful.


METHODS
1st case: a 6-year-old boy was admitted to the emergency department with contusion of the right flank caused by a road accident. The immediate test for haematuria was negative. Twenty-four hours after trauma, renal duplex ultrasound was performed due to the appearance of microscopic haematuria and it demonstrated trunkal thrombosis of the right renal artery, while the initial ultrasound was normal. 2nd case: a 15-year-old girl who jumped out of a window. 48 hours after the trauma, IVU was performed because of persistent microscopic haematuria and revealed a silent kidney, while the initial ultrasound was normal. Renal arteriography showed complete dissection of the right renal artery in both cases. Stenting was performed. The postoperative course was uneventful. In the first case, follow-up duplex ultrasound revealed a modification of the echostructure of the superior pole (absence of blood supply) while the lower pole had a normal interlobular blood supply. CT scan at the 2nd month confirmed normal excretion from the lower pole. In the first case, revascularization was satisfactory on the follow-up duplex ultrasound. After 20 months of follow-up, the kidney presented a normal functional and morphological appearance.


CONCLUSIONS
The diagnosis of renal pedicle lesions remains difficult and is based on emergency CT angiography. Treatment by vascular stenting can be performed in children. In some cases of renal artery dissection, it can constitute an alternative to surgery. However, it raises the question of the medium- and long-term repercussions of renal artery stenosis on the child's growth.
Merrot
T
T
Service de Chirurgie et Radiologie Pédiatriques, C.H.U. Nord, Marseille, France.
Portier
F
F
Galinier
P
P
Paul
J L
JL
Chaumoitre
K
K
Moscovici
J
J
Panuel
M
M
Alessandrini
P
P
D000293:Adolescent; D001807:Blood Vessel Prosthesis; D002648:Child; D005260:Female; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000293:injuries* / Q000601:surgery*; D008297:Male; D013997:Time Factors
Traumatisme du pédicule rénal chez l'enfant. A propos de deux cas de revascularisation tardive par prothèse endovasculaire.