[Arterial embolization in the treatment of renal trauma of a horseshoe kidney].
OBJECTIVE
To report one case of renal trauma in a patient with horseshoe kidney treated conservatively by superselective embolization.


METHODS
We report the case of a 19 year old male presenting at the emergency room with macroscopic hematuria and severe abdominal pain after a motor vehicular accident.


RESULTS
IV contrast CT scan showed a horseshoe kidney with a fracture in the area between the lower pole of the left kidney and the isthmus, with active bleeding and a big retroperitoneal hematoma extended to pelvis. Retarded exams showed contrast extravasation compatible with significant urinoma. Renal arteriography was performed, showing a double renal pedicle on each kidney and a common caudal lumbar-renal trunk giving accessory branches to both kidneys' lower poles and contrast extravasation compatible with active bleeding. The lumbar-renal trunk was selectively catheterized reaching the left kidney and isthmus branches which were embolized. Retrograde catheterization of the urinary tract with a straight ureteral catheter was performed to facilitate drainage of the urinoma. This catheter was subsequently removed after control CT scan showing complete resolution of the urinoma and no bleeding. Control CT scan three months after embolization demonstrated complete resolution of the hematoma. No late complications appeared. Renal function and blood pressure have been completely normal after 12 months of follow-up.


CONCLUSIONS
Horseshoe kidney is a rare congenital malformation. This clinical case demonstrates that conservative treatment is a still the gold standard treatment for renal trauma, even in kidneys with congenital anomalies.
Servicio de Urología y AngioRadiología, Hospitol Universitario Vall d'Hebron, Barcelona, España. doc99@eresmas.com
Salvador
S
Esquena Fernández
Enrique
E
Trilla Herrera
José María
JM
Abascal Junquera
Mercedes
M
Pérez
Juan
J
Morote Robles
D000328:Adult; D004621:Embolization, Therapeutic; D006406:Hematoma / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007668:Kidney / Q000002:abnormalities* / Q000293:injuries*; D007674:Kidney Diseases / Q000209:etiology / Q000628:therapy*; D008297:Male; D012077:Renal Artery