Blunt renal trauma in ureteropelvic junction obstruction kidney: A case report.

Int J Surg Case Rep

Department of Urology, Faculty of Medicine University of Padjadjaran, Hasan Sadikin Hospital Bandung, Bandung, West Java, Indonesia.

Published: May 2022

AI Article Synopsis

  • - Kidneys are commonly injured in trauma, particularly in cases of abdominal blunt trauma, and injuries in hydronephrotic kidneys due to ureteropelvic junction obstruction (UPJO) are rare but pose unique challenges.
  • - A case is presented involving a 23-year-old male who suffered abdominal blunt trauma in a motorcycle accident, leading to visible hematuria and grade IV hydronephrosis of the right kidney, detected through ultrasound and CT scans.
  • - Treatment included laparotomy and right nephrectomy due to severe kidney laceration, poor renal function, and the risk of future complications, highlighting the need for clinical judgment in managing renal injuries in patients with congenital abnormalities.

Article Abstract

Introduction: Kidneys are one of the most commonly affected retroperitoneal organ in trauma cases despite its relatively well-protected location. Renal trauma occurs in 80-95% of urogenital trauma cases and 8-10% of abdominal blunt trauma. Renal trauma in hydronephrotic kidney due to ureteropelvic junction obstruction (UPJO) is a rare entity, despite of high risk of trauma urogenital due to large size and thin parenchyma. In this case we reported blunt renal injury with a congenital abnormality of the kidney.

Case Presentation: We present a case of abdominal blunt trauma due to motor-vehicle accident in a 23 year old male patient. The patient complaint of visible hematuria since 1 day after falling from motorcycle with right flank hit the road, accompanied with right flank pain. Vital signs were within normal limits. Physical examinations reveal distention of right flank with no sign of peritonitis. Supporting examination with FAST ultrasound revealed grade 4 hydronephrosis with internal echo, suspected blood accumulation inside the kidney. Abdominal CT scan revealed grade IV hydronephrosis of right kidney with thin parenchyma. We performed laparotomy and renal exploration, intraoperatively we found multiple laceration of the kidney into pelvicalyceal system (AAST grade IV) with hematoma inside the right kidney and UPJ stenosis (about 5 cm). We decided to perform right nephrectomy despite of grade IV injury with consideration of poor renal function, long stenosis segment and thin renal parenchyma will cause many complications in the future for the patient.

Conclusion: Renal injury in UPJO kidney is a rare entity despite of high risk of injury in this population. Management of renal injury in this population might be not consistent with guideline for renal trauma, and clinical judgement from the physician plays an important role to provide the best treatment for this patient.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9046805PMC
http://dx.doi.org/10.1016/j.ijscr.2022.107005DOI Listing

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