The role of interventional radiology in the management of blunt renal injury: a practical protocol

Technology-driven triage of abdominal trauma: the emerging era of nonoperative management

Selective nonoperative management of blunt or penetrating abdominal trauma is safe, has eliminated the complications associated with nontherapeutic laparotomies, and is cost-effective. Appropriately selected investigations, such as focused abdominal sonography for trauma, diagnostic peritoneal lavage, spiral computed tomography (CT) scan, diagnostic laparoscopy, or thoracoscopy and angiography, play a critical role in the triage of patients. Future technological advances, such as improvement of the ultrasonic hardware and software that provide automated interpretation and the availability of portable CT scan machines in the emergency room, may improve the speed and accuracy of the initial evaluation. Improvement of the optical system of minilaparoscopes may allow reliable bedside laparoscopy for suspected diaphragmatic injuries.

[Renal trauma: is open surgery still up to date?]

For several years conservative treatment of renal trauma has been increasing. Investigation of circulatory conditions, renal ultrasound, and CT scan are necessary for assessing the extent of renal injury by the exact classifications of the organ injury scale. Through close cooperation of all departments involved, especially intensive care, traumatology, general surgery, radiology, and urology, it should be possible to limit primarily operative open surgery to life-threatening renal bleeding (grade V). All other cases require a repeat diagnosis for control purposes after 2-4 days. Complications found then can for the most part be treated conservatively or by minimally invasive techniques. Thus, open operative intervention has been minimized in these cases too.