[Renal trauma stage IV in a boy treated in a nonoperative form. Report of a clinical case].
The clinical case of a 6 years old boy, who presented severe right renal trauma with rupture of the pyelocaliceal system and renal injury (IV grade), is reported. Upon admittance to emergency he presented paleness, tachycardia, rapid pulse, intense pain in the right lumbar region and macroscopic hematuria. Using abdominal ultrasound scan, an injury of the right renal parenchyma with perirenal collection was shown. Hematology studies showed a decrease in the hemoglobin count of 3,1 g% during the first posttraumatic 48 hours. A non-surgical conservative treatment was decided, since the patient's hemodynamic status held stable despite the hemoglobin alterations. To treat renal injury, a percutaneous catheter drainage was placed in the right perirenal space on day 16th from the accident. The patient was released after this treatment and was controlled as an outpatient, until the rupture of the excretory urinary system was sealed (3 weeks), when the patient returned to have the catheter removed. The patient's progress was excellent, the kidney was preserved and no complications have occurred in a 6 months follow up after the injury. The non-surgical treatment in renal trauma with injury to the excretory system is effective and advisable in children, provided the patients are hemodynamically stable.
Servicio de Cirugía Pediátrica, Hospital Universitario de Maracaibo, Venezuela. jafernandezf@cantv.net
Jesús
J
Fernández-Fernández
Gerardo
G
Robles
Lui
L
Amado-Medina
Elizabeth
E
Rincón-Márquez
Freddy
F
Pachano-Arenas
D000058:Accidental Falls; D002648:Child; D004322:Drainage; D006417:Hematuria / Q000209:etiology; D006439:Hemodynamics; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D009403:Nephrostomy, Percutaneous; D012421:Rupture / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D053584:Urinoma / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D014567:Urography; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000601:surgery*