Search

腎外傷25例のIVPおよびCT像について検討した.25例の腎外傷の程度をIVPで分類すると, 腎挫傷13例, 腎裂傷11例, 腎断裂1例であった.25例中, CT scanも施行した14例について検討した結果, CT scanは腎外傷の程度, とくに腎周囲血腫の診断に有用であった.腎周囲血腫はCT scanで7例に明らかに認められたが, IVPでは, 腎輪郭と腸腰筋の不鮮明が腎周囲血腫の存在を示唆するものと考えられた.腎周囲血腫はすべて保存的治療で吸収されたが, 7例中5例は3ヵ月以内であった, We experienced 25 cases of renal trauma in our hospitals during the past 5 years, 20 cases were male and 5 cases were female, ranging in age 10 to 51 years old with average 26 years old, and the chief complaints were gross-hematuria and pain of renal region. We studied the IVP and CT patterns of these cases. IVP revealed 13 cases of renal contusion, 11 cases of renal lacerated wound and 1 case of renal fragmentation. The CT scan of 14 cases showed that it was useful for the diagnosis of the degree of renal trauma, especially, for hematoma surroundings the kidneys. The hematoma surrounding the kidneys was clearly noted in 7 cases by CT scan, but the unclearness of renal contours and iliopsoas muscle was considered to suggest the existence of hematoma surrounding the kidneys by IVP. All of the hematoma surrounding the kidneys was absorbed by conservative therapy, but 5 of the 7 cases were treated within 3 months.

Two cases of congenital hydronephrosis discovered by renal trauma are reported. The first case was a 15-year-old girl. When she was practicing KENDO, her Hakama clung to her legs, and she tumbled. She had emergency operation for abdominal injury. At surgery, no evidence of abdominal injury was detected. Renal trauma was suspected. Right renal angiography revealed hydronephrosis. The second case was a 23-year-old girl, complaining of abdominal pain after stumbling over a block. Intravenous pyelography showed no visualization of the right kidney and CT scan showed an abnormal shadow. Retrograde pyelography and angiography revealed right hydronephrosis. Including our two cases, 47 cases of renal traumata occurring in hydronephrotic kidney in the Japanese literature were reviewed. Thirty five of these cases were males. Many were youths under the age of twenty. Various sports caused many of the renal traumata. 37 of these cases were treated by nephrectomy.

To document the severity and degree of renal injury multiple studies may be necessary, including excretory urography, nephrotomography, arteriography and ultrasonographic examination. Even these extensive studies fail at times to provide sufficient information for treatment of the injury. However, the parenchymal injuries and extrarenal hematomas are depicted more accurately by computed tomography (CT). Moreover, dynamic CT can assess parenchymal enhancement during the capillary phase. Therefore, dynamic CT is useful in assessing the renal contusion and hematoma. In addition, it appears to be highly reliable and relatively noninvasive means of diagnosing renal trauma.

Apresentamos uma revisão sobre trauma renal, com ênfase na avaliação radiológica, particularmente com o uso da tomografia computadorizada, que tem se tornado o exame de eleição, ao invés da urografia excretora e arteriografia. O sucesso no tratamento conservador dos pacientes com trauma renal depende de um acurado estadiamento da extensão da lesão, classificado de acordo com a Organ Injury Scaling do Colégio Americano de Cirurgiões. O tratamento conservador não-operatório é seguro e consiste de observação contínua, repouso no leito, hidratação endovenosa adequada e antibioti- coterapia profilática, evitando-se uma exploração cirúrgica desnecessária e possível perda renal. As indicações para exploração cirúrgica imediata são abdome agudo, rápida queda do hematócrito ou lesões associadas determinadas na avaliação radiológica. Quando indicada, a exploração renal após controle vascular prévio é segura, permitindo cuidadosa inspeção do rim e sua reconstrução com sucesso, reduzindo a probabilidade de nefrectomia.

Herein we report a case of acute renal failure after renal trauma in a patient with contralateral hypoplastic kidney. The patient was treated conservatively including temporary hemodialysis successfully. In the case of renal trauma, the status and function of the contralateral kidney must be evaluated first, and in the case of a solitary kidney, treatment should be centered on the preservation of its function.

The management of blunt renal trauma has been evolving. The past management largely based on American Association for Surgery of Trauma (AAST) grading system, i.e. necessitated a computed tomography (CT) scan. Although the CT scan use is increasing and becomes the standardized mode of investigation, AAST grading no longer plays the sole role in the decision of surgical interventions. Two case reports of blunt renal trauma managed successfully by conservative methods are presented.Case one was an 18 year-old boy who had a fall when riding a motorbike at 20 km/h with a helmet and full protective equipments. He was landed by his left flank onto a rock. Contrast abdominal CT revealed a 4 cm, grade III splenic tear and a grade IV left kidney injury with large perirenal haematoma. His international severity score (ISS) was 34. He was managed conservatively with bed rest and frequent serum haemoglobin monitoring. Subsequent CT with delayed contrast revealed stable perirenal haematoma with urine extravasation which was consistent with a grade IV renal injury. Case two was a 40 year-old male who had a motor bike accident on a racetrack when he was driving at 80 to 100 km/h, wearing a helmet. He lost control and hit onto the sidewall of the racetrack. Contrast abdominal CT revealed a grade IV left renal injury with a large urine extravasation. His renal injury was managed conservatively with interval delayed phase CT of the abdomen. A repeat CT on abdomen was performed five months after the initial injury which revealed no residual urinoma.In this study, moreover, a review of the literature to the management of blunt renal trauma was conducted to demonstrate the trend of increasing conservative management of such traumas. Extra radiological parameters may guide future decision making. However, the applicability of data may be limited until randomized trials are available.

We experienced 25 cases of renal trauma in our hospitals during the past 5 years, 20 cases were male and 5 cases were female, ranging in age 10 to 51 years old with average 26 years old, and the chief complaints were gross-hematuria and pain of renal region. We studied the IVP and CT patterns of these cases. IVP revealed 13 cases of renal contusion, 11 cases of renal lacerated wound and 1 case of renal fragmentation. The CT scan of 14 cases showed that it was useful for the diagnosis of the degree of renal trauma, especially, for hematoma surroundings the kidneys. The hematoma surrounding the kidneys was clearly noted in 7 cases by CT scan, but the unclearness of renal contours and iliopsoas muscle was considered to suggest the existence of hematoma surrounding the kidneys by IVP. All of the hematoma surrounding the kidneys was absorbed by conservative therapy, but 5 of the 7 cases were treated within 3 months.

Two cases of congenital hydronephrosis discovered by renal trauma are reported. The first case was a 15-year-old girl. When she was practicing KENDO, her Hakama clung to her legs, and she tumbled. She had emergency operation for abdominal injury. At surgery, no evidence of abdominal injury was detected. Renal trauma was suspected. Right renal angiography revealed hydronephrosis. The second case was a 23-year-old girl, complaining of abdominal pain after stumbling over a block. Intravenous pyelography showed no visualization of the right kidney and CT scan showed an abnormal shadow. Retrograde pyelography and angiography revealed right hydronephrosis. Including our two cases, 47 cases of renal traumata occurring in hydronephrotic kidney in the Japanese literature were reviewed. Thirty five of these cases were males. Many were youths under the age of twenty. Various sports caused many of the renal traumata. 37 of these cases were treated by nephrectomy.

Herein we report a case of acute renal failure after renal trauma in a patient with contralateral hypoplastic kidney. The patient was treated conservatively including temporary hemodialysis successfully. In the case of renal trauma, the status and function of the contralateral kidney must be evaluated first, and in the case of a solitary kidney, treatment should be centered on the preservation of its function.

To document the severity and degree of renal injury multiple studies may be necessary, including excretory urography, nephrotomography, arteriography and ultrasonographic examination. Even these extensive studies fail at times to provide sufficient information for treatment of the injury. However, the parenchymal injuries and extrarenal hematomas are depicted more accurately by computed tomography (CT). Moreover, dynamic CT can assess parenchymal enhancement during the capillary phase. Therefore, dynamic CT is useful in assessing the renal contusion and hematoma. In addition, it appears to be highly reliable and relatively noninvasive means of diagnosing renal trauma.