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't Hoen LA, O'Kelly F, Lammers RJM, Dönmez Mİ, Baydilli N, Sforza S, Bindi E, Atwa A, Haid B, Quiroz Y, Marco BB. Mobility and Sporting Activity After Renal Trauma: A Survey Regarding Best Clinical Practice During the Recovery Stage. Urology 2024; 183:199-203. [PMID: 37806456 DOI: 10.1016/j.urology.2023.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To evaluate strategies that are followed after pediatric renal trauma during the recovery stage, with an emphasis on mobility and involvement in subsequent sporting activities. Renal trauma is the most common urogenital trauma in children. The American Association for the Surgery of Trauma (AAST) scale is most commonly used to stratify the severity of injury. There is no consensus in the existing literature with respect to the recovery stage following renal trauma. METHODS A survey was constructed by the European Association of Urology (EAU) - Young Academic Urologists (YAU) Pediatric Urology Working Group and then made digitally available on SurveyMonkey. The survey consists of 15 questions exploring relevant factors and timing to start again with mobility and activity. RESULTS In total 153 people responded, of whom 107 completed the entire survey. The presence of pain and severity of trauma were acknowledged as most important factors to commence mobilization, whereas presence of hematuria was identified as an additional factor for sporting activity. Regardless of severity of trauma a minimum of 90% of respondents recommend return to noncontact sports within 12weeks. For contact sports, a minimum of 33% of respondents advised >12weeks minimum before starting again. A small number of respondents would never allow sporting activities again. CONCLUSION The time to allow sporting activity shows high variation among the respondents, some even restricting sporting activities completely. This survey highlights the need for a standardized protocol based on multicenter follow-up data.
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Affiliation(s)
- Lisette A 't Hoen
- Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Fardod O'Kelly
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Rianne J M Lammers
- Department of Urology, University Medical Center Groningen, Groningen, the Netherlands
| | | | | | | | | | - Ahmed Atwa
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Bernard Haid
- Ordensklinikum Linz, Barmherzige Schwestern Hospital, Linz, Austria
| | - Yesica Quiroz
- Department of Urology, Division of Pediatric Urology, Fundació Puigvert, Barcelona, Spain
| | - Beatriz Bañuelos Marco
- Department of Urology, Renal Transplant Division, University Hospital El Clinico, Madrid, Spain
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Kim K, Ha G, Jang SW, Jang JY, Bae KS. Determination of the radiologic findings for predicting failure of conservative management with observation for blunt renal injury patients: A single-centre experience over 13 years. Injury 2021; 52:2588-2593. [PMID: 34134853 DOI: 10.1016/j.injury.2021.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 05/10/2021] [Accepted: 05/28/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Most blunt renal injuries (BRIs) are managed conservatively without complications. Because conservative management with observation (CMO) is widely conducted, failed CMO is frequent. Clarifying the role and indication of CMO is important to manage BRI patients. Therefore, this study was conducted to analyse factors related to failed CMO. METHODS BRI patients (aged >13 years) who were admitted via the emergency department in Wonju Severance Christian Hospital were analysed retrospectively between January 2008 and July 2020. Patient characteristics, including clinical data, laboratory findings, transfusion requirements, injury grade, initial CT findings, length of hospital stay, intensive care unit stay, and mortality, were investigated for all enrolled patients. RESULTS Kidney injury grade ≥ 4, perinephric haematoma rim distance (PHD), length of main laceration, intravascular contrast extravasation (ICE), Gerota's fascia discontinuity, multiple lacerations, dissociated renal fragment and complexity of laceration were statistically significantly different between the successful CMO and failed CMO groups in the comparative analysis. The multivariate analysis showed that perinephric haematoma rim distance [odds ratio (OR) 1.44 [95% confidence interval (CI) 1.09 - 1.90], p = 0.011] and ICE [OR 7.41 (95% CI 2.20 - 24.99), p = 0.001] were mutually independent risk factors associated with failed CMO. When the ROC curve of PHD and ICE was generated to predict the failure of CMO, the area under the curve (AUC) was 0.884 (95% CI, 0.826 - 0.942), p < 0.001), and the optimal cut-off value for PHD was 2.9 cm, and for ICE was presence of ICE on CT [sensitivity: 90.5% (95% CI, 0.70 - 0.99), specificity: 78.0% (95% CI, 0.73 - 0.83)]. CONCLUSION PHD and ICE may be useful factors to predict failed CMO for BRI patients. PHD > 2.9 cm and the presence of ICE may indicate who will require invasive procedures. Close observation is wise for patients with these risk factors.
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Affiliation(s)
- Kwangmin Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea; Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea
| | - Gaesung Ha
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea; Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea
| | - Sung Woo Jang
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea; Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea
| | - Ji Young Jang
- Department of Surgery, Trauma Center, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Keum Seok Bae
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea; Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea.
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Dillman JR, Rigsby CK, Iyer RS, Alazraki AL, Anupindi SA, Brown BP, Chan SS, Dorfman SR, Falcone RA, Garber MD, Nguyen JC, Peters CA, Safdar NM, Trout AT, Karmazyn BK. ACR Appropriateness Criteria ® Hematuria-Child. J Am Coll Radiol 2019; 15:S91-S103. [PMID: 29724430 DOI: 10.1016/j.jacr.2018.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 02/01/2023]
Abstract
Hematuria is the presence of red blood cells in the urine, either visible to the eye (macroscopic hematuria) or as viewed under the microscope (microscopic hematuria). The clinical evaluation of children and adolescents with any form of hematuria begins with a meticulous history and thorough evaluation of the urine. The need for imaging evaluation depends on the clinical scenario in which hematuria presents, including the suspected etiology. Ultrasound and CT are the most common imaging methods used to assess hematuria in children, although other imaging modalities may be appropriate in certain instances. This review focuses on the following clinical variations of childhood hematuria: isolated hematuria (nonpainful, nontraumatic, and microscopic versus macroscopic), painful hematuria (ie, suspected nephrolithiasis or urolithiasis), and renal trauma with hematuria (microscopic versus macroscopic). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Jonathan R Dillman
- Principal Author, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Cynthia K Rigsby
- Panel Chair, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ramesh S Iyer
- Panel Vice Chair, Seattle Children's Hospital, Seattle, Washington
| | | | | | - Brandon P Brown
- Riley Hospital for Children Indiana University, Indianapolis, Indiana
| | | | | | - Richard A Falcone
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; American Pediatric Surgical Association
| | - Matthew D Garber
- Wolfson Children's Hospital, Jacksonville, Florida; American Academy of Pediatrics
| | - Jie C Nguyen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Craig A Peters
- UT Southwestern Medical Center, Dallas, Texas; Society for Pediatric Urology
| | | | - Andrew T Trout
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Boaz K Karmazyn
- Specialty Chair, Riley Hospital for Children Indiana University, Indianapolis, Indiana
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Barras M, Pearson E, Cousin I, Le Rouzic C, Thepaut M, Gentric JC, Roue JM, Yevich S, de Vries P. Renal artery embolization in a child with delayed hemodynamic instability from penetrating knife wound. Arch Pediatr 2018; 25:S0929-693X(18)30113-1. [PMID: 29909939 DOI: 10.1016/j.arcped.2018.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 02/22/2018] [Accepted: 05/20/2018] [Indexed: 11/24/2022]
Abstract
Penetrating laceration injury in the pediatric population may present as an acute or delayed life-threatening injury. Although emergent intra-arterial embolization is commonly utilized in adults, few cases have been reported for children. Surgical treatment for severe renal laceration injuries may require complete nephrectomy; an unfortunate outcome for a pediatric patient if a renal-preserving alternative is feasible. We present a case of penetrating renal laceration in a 10-year-old boy treated with intra-arterial embolization of the lacerated dominant renal artery and subsequent renal perfusion by an uninjured accessory renal artery allowing for renal preservation.
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Affiliation(s)
- M Barras
- Pediatric surgery department, CHU de Brest, 2, avenue Foch, 29609 Brest cedex, France.
| | - E Pearson
- Interventional Radiology department, CHU de Brest, boulevard Tanguy-Prigent, 29000 Brest, France
| | - I Cousin
- Pediatric surgery department, CHU de Brest, 2, avenue Foch, 29609 Brest cedex, France
| | - C Le Rouzic
- Pediatric surgery department, CHU de Brest, 2, avenue Foch, 29609 Brest cedex, France
| | - M Thepaut
- Pediatric surgery department, CHU de Brest, 2, avenue Foch, 29609 Brest cedex, France
| | - J-C Gentric
- Interventional Radiology department, CHU de Brest, boulevard Tanguy-Prigent, 29000 Brest, France
| | - J-M Roue
- Pediatric department, CHU de Brest, 2, avenue Foch, 29609 Brest cedex, France
| | - S Yevich
- Gustave Roussy Cancer Campus Grand Paris, Interventional Radiology department, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - P de Vries
- Pediatric surgery department, CHU de Brest, 2, avenue Foch, 29609 Brest cedex, France
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Evaluation of the management of severe trauma kidney injury and long-term renal function in children. J Trauma Acute Care Surg 2018; 84:951-955. [PMID: 29462089 DOI: 10.1097/ta.0000000000001854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND To evaluate the management and long-term renal function with DMSA scintigraphy in pediatric severe traumatic kidney injury grade IV and V at the trauma center of Grenoble Teaching Hospital. METHODS This is a single-center observational retrospective study between 2004 and 2014. All children younger than 15 years and managed at the Grenoble teaching Hospital for a severe trauma kidney injury grade IV or V were included. The trauma grade was radiologically diagnosed on arrival at hospital, using the classification of the American Association for Surgery of Trauma. The management followed the algorithm in effect in the establishment. The assessment of the renal function was performed by a DMSA scintigraphy after at least 6 months from the injury. RESULTS Twenty-one children were managed for a severe renal trauma (16 IV and 5 V). The diagnosis was initially made by an ultrasonography (eight cases) or a computed tomography scan (13 cases). A child with a severe renal trauma IV underwent nephrectomy on day 6 of the trauma. Eleven children needed a therapeutic procedure (three embolizations, four double J stents, one arterial stent, one peritoneal lavage for a splenic hemoperitoneum, four pleural drainages). A DMSA scintigraphy was performed in 15 patients to assess the function of the injured kidney: 11 of 16 severe renal trauma IV with an average of 39.4%, and 17% in 4 of 5 severe renal trauma V analyzed. CONCLUSION Among the 21 children managed for a severe kidney trauma injury IV or V, 11 required a therapeutic procedure, one of them a nephrectomy. The DMSA scintigraphy performed after at least 6 months from the trauma found an injured renal function at 39.4% in 11 of 16 severe renal trauma IV analyzed, and 17% in 4 of 5 severe renal trauma V analyzed, which confirms the currently conservative management. LEVEL OF EVIDENCE Type of study: original article, retrospective observational study, level IV.
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Guyot R, Arnoux V, Descotes JL, Terrier N, Boillot B, Thuillier C, Rambeaud JJ, Long JA, Fiard G. Prise en charge des pseudo-anévrismes rénaux intraparenchymateux post-traumatiques : à propos d’une série de 325 patients traumatisés rénaux. Prog Urol 2017; 27:190-199. [DOI: 10.1016/j.purol.2016.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 12/07/2016] [Accepted: 12/28/2016] [Indexed: 11/24/2022]
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Abstract
In the last decade, higher rates of nonoperative management of liver, spleen, and kidney injuries have been achieved. An algorithmic approach may improve success on a national level. Factors for success include management strategy based on physiologic status of the child, early attempt at resuscitation using blood products, and appropriate use of adjuncts. Shorter hospitalizations are appropriate for children who have not bled significantly, and discharge instructions facilitate the safety of early discharge. Although routine imaging is not required for liver or spleen injury, symptoms should prompt reevaluation. Reimaging of renal injuries remains in common use.
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Shuaib W, Tiwana MH, Vijayasarathi A, Sadiq MF, Anderson S, Amin N, Khosa F. Imaging of vascular pseudoaneurysms in the thorax and abdomen. Clin Imaging 2015; 39:352-62. [PMID: 25682302 DOI: 10.1016/j.clinimag.2015.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 12/27/2014] [Accepted: 01/14/2015] [Indexed: 12/17/2022]
Abstract
INTRODUCTION This review article illustrates a spectrum of arterial pseudoaneurysms that may occur in various locations throughout the thoracoabdominal region. This article discusses the common etiologies and typical clinical presentations of arterial pseudoaneurysms as well as the imaging modalities employed in their diagnosis and potential treatment options. OBJECTIVE The goal of this review article is to familiarize radiologists with the diagnosis of thoracoabdominal arterial pseudoaneurysms, the prompt identification and treatment of which are crucial in this patient population. CONCLUSION In summary, a thorough understanding of the etiologies, imaging characteristics, and clinical implications of pseudoaneurysms can help optimize identification and management of this spectrum of disease.
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Affiliation(s)
- Waqas Shuaib
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA.
| | | | - Arvind Vijayasarathi
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA
| | | | - Stephen Anderson
- Department of Radiology, Boston University School of Medicine, Boston, MA
| | - Neil Amin
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA
| | - Faisal Khosa
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA
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9
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Antunes-Lopes T, Pinto R, Morgado P, Madaleno P, Silva J, Silva C, Cruz F. Intrarenal artery pseudoaneurysm after blunt abdominal trauma: a case report of successful superselective angioembolization. Res Rep Urol 2014; 6:17-20. [PMID: 24809039 PMCID: PMC3979790 DOI: 10.2147/rru.s58291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Renal artery pseudoaneurysm is a very rare complication after blunt trauma injury. We report on a case of a 54-year-old man admitted to our hospital for right flank pain and gross hematuria, 5 days after blunt abdominal trauma. The diagnosis of interlobar renal pseudoaneurysm was established by a computed tomography scan and confirmed by angiography. Successful superselective angioembolization was performed. This radiographic intervention is an effective and minimally invasive technique to stop active bleeding from renal artery pseudoaneurysms, when patients are hemodynamically stable and where technically feasible. A review of the literature was carried out.
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Affiliation(s)
- T Antunes-Lopes
- Department of Urology, Hospital de São João, Porto, Portugal ; Faculty of Medicine, University of Porto, Porto, Portugal
| | - R Pinto
- Department of Urology, Hospital de São João, Porto, Portugal ; Faculty of Medicine, University of Porto, Porto, Portugal
| | - P Morgado
- Department of Radiology, Hospital de São João, Porto, Portugal
| | - P Madaleno
- Department of Radiology, Hospital de São João, Porto, Portugal
| | - J Silva
- Department of Urology, Hospital de São João, Porto, Portugal ; Faculty of Medicine, University of Porto, Porto, Portugal
| | - C Silva
- Department of Urology, Hospital de São João, Porto, Portugal ; Faculty of Medicine, University of Porto, Porto, Portugal
| | - F Cruz
- Department of Urology, Hospital de São João, Porto, Portugal ; Faculty of Medicine, University of Porto, Porto, Portugal
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Yokoyama S, Sekioka A, Utsunomiya H, Shimada K. Traumatic renal artery occlusion associated with a grade III hepatic injury in an 11-year-old boy: A case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Yang HK, Koh ES, Shin SJ, Chung S. Incidental renal artery pseudoaneurysm after percutaneous native renal biopsy. BMJ Case Rep 2013; 2013:bcr-2012-006537. [PMID: 23440983 DOI: 10.1136/bcr-2012-006537] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Renal artery pseudoaneurysm (RAP) is an uncommon but potentially life-threatening condition that is often difficult to diagnose. Rarely, it can occur as a complication associated with a percutaneous renal biopsy procedure. The clinical manifestations vary from asymptomatic lesions found incidentally on imaging studies to a mass causing high blood pressure, pain, haematuria and rupture. Although the risk of rupture is considered low, RAP is associated with a high death rate if ruptured. Currently, with the aid of high-quality interventional radiology, this challenging pathology can be effectively treated. In this report, we describe a case of RAP that was incidentally discovered 4 years after percutaneous renal biopsy which was successfully treated with selective angiographic embolisation.
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Affiliation(s)
- Hae Kyung Yang
- Deparment of Internal Medicine, The Catholic University of Korea Seoul St Mary's Hospital, Seoul, Republic of Korea
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Yamaçake KGR, Lucon M, Lucon AM, Mesquita JLB, Srougi M. Renal artery pseudoaneurysm after blunt renal trauma: report on three cases and review of the literature. SAO PAULO MED J 2013; 131:356-62. [PMID: 24310805 PMCID: PMC10876317 DOI: 10.1590/1516-3180.2013.1315488] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 03/06/2013] [Indexed: 11/22/2022] Open
Abstract
CONTEXT Renal artery pseudoaneurysm is a rare complication after renal injury but should be suspected whenever there is recurrent hematuria after renal trauma. CASE REPORTS We present three cases of pseudoaneurysm after blunt renal trauma and a review of the literature. All patients underwent renal angiography. Two cases were diagnosed during the initial hospital stay due to hematuria, or in the follow-up period during recovery. One patient was hemodynamically unstable. Two patients successfully underwent coil embolization in a single session. In the other case, selective embolization was attempted, but was unsuccessful because artery catheterization was impossible. Procedural and medical success and complications were retrospectively assessed from the patients' records. The clinical presentation, treatment options and clinical decisions are discussed. CONCLUSIONS Renal artery pseudoaneurysm may develop acutely or even years after the initial injury. Signs and symptoms may have a wide spectrum of presentation. Selective angiographic embolization is an effective treatment that reduces the extent of parenchymal infarction.
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Affiliation(s)
- Kleiton Gabriel Ribeiro Yamaçake
- Resident, Department of Urology, Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Marcos Lucon
- MD. Attending Physician, Department of Urology, Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Antonio Marmo Lucon
- MD, PhD. Assistant Professor, Department of Urology, Hospital das Cl ínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - José Luiz Borges Mesquita
- MD. Attending Physician, Department of Urology, Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Miguel Srougi
- MD, PhD. Professor and Head, Department of Urology, Hospital das Cl ínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
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Non-operative management of renal trauma in very young children: experiences from a dedicated South African paediatric trauma unit. Injury 2012; 43:1476-81. [PMID: 21269622 DOI: 10.1016/j.injury.2010.12.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2010] [Revised: 12/17/2010] [Accepted: 12/23/2010] [Indexed: 02/02/2023]
Abstract
Blunt abdominal trauma results in renal injury in 10% of paediatric cases. Over the last twenty years, the management of paediatric renal trauma has shifted towards a primarily non-operative approach that is now well-established for children up to 18 years old. This retrospective study reviews our experiences of non-operatively managing blunt renal trauma in a very young cohort of patients up to 11 years old. Between June 2006 and June 2010, 118 children presented to the Red Cross War Memorial Children's Hospital in Cape Town with blunt abdominal trauma. 16 patients shown to have sustained renal injury on abdominal computed tomography (CT) scanning were included in this study. Medical records were reviewed for the mechanism of injury, severity of renal injury, clinical presentation, associated injuries, management method and clinical outcomes. All renal injuries were graded (I-V) according to the American Association for the Surgery of Trauma Organ Injury Severity Scale. All renal trauma patients included in this study were aged between 1 and 11 years (mean of 6.5 years). 1 patient sustained grade V injuries; 2 grade IV, 6 grade III and 7 grade I injuries. The majority of injuries (9/16) were caused by motor vehicle crashes, whilst 5 children fell from height, 1 was struck by a falling tree and 1 hit by a moving train. 1 of 16 patients was haemodynamically unstable on presentation as a result of multiple splenic and hepatic lacerations. He was resuscitated and underwent immediate laparotomy. However, his renal injuries were not indications for surgical management. 15 haemodynamically stable patients were non-operatively managed for their renal injuries. Following lengths of admissions ranging from 4 to 132 days, all 16 patients were successfully discharged with no mortalities. No significant complications of renal trauma, such as new-onset hypertension, were detected during their first follow up outpatient appointments. Our findings successfully extend non-operative management of haemodynamically stable renal injuries to a very young cohort up to 11 years old. However, we still advocate immediate resuscitation and surgical intervention for any haemodynamically unstable child who had sustained any abdominal injury. We also argue for a limited role for abdominal CT imaging for diagnosing renal injury and routine follow up, instead recommending a greater emphasis on clinical observations for possible complications.
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Gouli JC, Merrot T, Kalfa N, Faure A, Chaumoître K, Galifer RB, Alessandrini P. [Outcome of severe closed kidney injuries in children]. Prog Urol 2011; 22:58-62. [PMID: 22196007 DOI: 10.1016/j.purol.2011.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 07/06/2011] [Accepted: 07/07/2011] [Indexed: 11/20/2022]
Abstract
AIMS To analyze the results of treatment of major renal injuries according imaging data in order to determine their function after follow-up. PATIENTS AND METHODS This is a retrospective study of 22 cases of fracture of the kidney (grade V) in two pediatric surgical services that were reviewed over a period of 16 years. After initial conservative treatment in 19 patients (86.5%), a scan and/or Uro-MRI were realized in all patients in monitoring evolving. Three children with vascular injury were treated by interventional radiology. The morphology and functional evolution of the injured kidney were determined. RESULTS A DMSA scan investigation was performed in 21 patients (95.5%) associated with Uro-MRI in two cases; one patient was only explored with Uro-MRI. A complete restitution of the renal parenchyma was confirmed in 10 children (45.5%), we noted an atrophy of the upper pole in 30%, a lower pole atrophy in 4.5%, two complete renal atrophy in 9%. An urinoma was present in six patients (27%) that required drainage in five cases and declined during the surveillance in one case. Normal function of the injured kidney was noticed in half of grade V (11 of 22 patients) with a mean follow-up of 19 months. None of our patients did present hypertension. CONCLUSION Non-operative conservative treatment in severe renal trauma was efficient, morphological and functional sequelae were present in 50% on scintigraphy and/or Uro-MRI.
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Affiliation(s)
- J-C Gouli
- Service de chirurgie infantile, CHU Nord, Assistance publique-Hôpitaux de Marseille, université Méditerranée, chemin des Bourrely, 13915 Marseille cedex 20, France
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Radiological Treatment of Renal Artery Occlusion After Blunt Abdominal Trauma in a Pediatric Patient: Is It Never Too Late? Urology 2011; 77:1220-2. [DOI: 10.1016/j.urology.2010.06.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2010] [Revised: 05/23/2010] [Accepted: 06/19/2010] [Indexed: 11/18/2022]
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Angiographic embolization is safe and effective therapy for blunt abdominal solid organ injury in children. ACTA ACUST UNITED AC 2010; 68:526-31. [PMID: 20220415 DOI: 10.1097/ta.0b013e3181d3e5b7] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND : Angiographic embolization (AE) is used to control hemorrhage in adult blunt liver, spleen, and kidney (ASO) injuries. Pediatric experience with AE for blunt ASO injuries is limited. We reviewed our use of AE to control bleeding pediatric blunt ASO injuries for efficacy and safety. METHODS : A 5-year review (trauma registry and charts) of children (age < or = 16 years) who had AE for hemorrhage from blunt ASO injuries. Nonoperative management was attempted in all stable children with blunt ASO injuries. Children with ongoing hemorrhage underwent AE. The success of AE and complications were evaluated. Data were reviewed on injury type and grade, injury severity score, length of intensive care unit stay (LOS-ICU) and length of hospital stay (LOS), and complications. RESULTS : One hundred twenty-seven patients with 149 blunt ASO injuries were identified (72 spleen, 51 liver, and 26 renal). Two children had immediate splenectomies. Seven children underwent AE: two spleen (grades IV and V), two liver (grades III and IV), and three grade IV renal injuries. Three children received blood before embolization. Mean age and injury severity score were 12.3 years +/- 3.7 years and 22.4 +/- 10.0,respecyively. Mean intensive care unit stay was 4.8 days +/- 5.5 days with a mean length of hospital stay of 12.8 days +/- 5.5 days. Embolization was successful in all children; there were no procedure-related complications. Four minor complications occurred; two pleural effusions and two patients with transient hypertension. A nephroblastoma was later found in one renal injury requiring nephrectomy. CONCLUSIONS : AE is a safe and an effective technique for controlling hemorrhage from blunt ASO injuries in select pediatric patients.
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Mima A, Toma M, Matsubara T, Shiota F, Iehara N, Abe H, Nagai K, Takahashi T, Matsuura M, Murakami T, Kishi S, Araoka T, Kishi F, Kondo N, Shigeta R, Yoshikawa K, Kimura T, Kita T, Doi T, Fukatsu A. Angio-embolization of renal artery pseudoaneurysm after renal biopsy: a case report. Ren Fail 2010; 31:753-5. [PMID: 19814646 DOI: 10.3109/08860220903125298] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Renal artery pseudoaneurysm is a rare clinical entity that has been reported after renal biopsy, percutaneous renal surgery, penetrating trauma, and rarely blunt renal trauma. We present the case of a 37-year-old man with ruptured renal artery pseudoaneurysm accompanied by massive gross hematuria, urinary clot retention, and bladder tamponade, which were the presenting signs seven hours after renal biopsy. Abdominal CT scan showed a large perinephric, intracapsular hematoma of left kidney. His angiogram revealed a left renal segmental artery pseudoaneurysm that measured 1 cm x 1 cm. He was successfully treated by selective embolization of the arterial branch supplying the pseudoaneurysm.
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Affiliation(s)
- Akira Mima
- Department of Nephrology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima 770-8503, Japan.
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Lindekleiv H, Haro S, Nordhus K, Eggen T, Due J. Renal artery pseudoaneurysm secondary to blunt trauma nine years earlier: Case report and review of the literature. ACTA ACUST UNITED AC 2009; 42:488-91. [DOI: 10.1080/00365590802045137] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Haakon Lindekleiv
- Departments of Urology and Endocrine Surgery, Faculty of Medicine, University of Tromsø
| | - Sergio Haro
- Departments of Urology and Endocrine Surgery, Faculty of Medicine, University of Tromsø
| | - Kåre Nordhus
- Radiology, Faculty of Medicine, University of Tromsø
| | - Tormod Eggen
- Pathology, Faculty of Medicine, University of Tromsø, University Hospital of North Norway, Tromsø, Norway
| | - Jan Due
- Departments of Urology and Endocrine Surgery, Faculty of Medicine, University of Tromsø
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Spontaneous Resolution of Blunt Trauma Renal Artery Pseudoaneurysm and Reno-Caval Fistula. ACTA ACUST UNITED AC 2009; 66:E67-9. [DOI: 10.1097/ta.0b013e31804797fb] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Single Center Experience With Application of the ALARA Concept to Serial Imaging Studies After Blunt Renal Trauma in Children—Is Ultrasound Enough? J Urol 2009; 181:1834-40; discussion 1840. [DOI: 10.1016/j.juro.2008.12.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Indexed: 11/18/2022]
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Eassa W, El-Ghar MA, Jednak R, El-Sherbiny M. Nonoperative management of grade 5 renal injury in children: does it have a place? Eur Urol 2009; 57:154-61. [PMID: 19223117 DOI: 10.1016/j.eururo.2009.02.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2008] [Accepted: 02/02/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND Nonoperative treatment of blunt renal trauma in children is progressively gaining acceptance; grade 5 renal trauma is associated with a significant rate of complications. OBJECTIVE To assess the feasibility and outcome of initial nonoperative management of grade 5 blunt renal trauma in children. DESIGN, SETTING, AND PARTICIPANTS This retrospective study included 18 children (12 boys and 6 girls; mean age: 8.4+/-3.4 yr) who presented to the authors' institutes with grade 5 blunt renal trauma between 1990 and 2007. MEASUREMENTS An intravenous contrast-enhanced computed tomography (CT) scan demonstrated grade 5 renal trauma in all patients. Associated major vascular injuries were suspected in four patients. All were initially managed conservatively. Indications for intervention included hemodynamic instability, progressive urinoma, or persistent bleeding. Dimercaptosuccinic acid (DMSA) scans were performed at a mean time of 3.1 yr (range: 1-17) following the injury in nine patients. RESULTS AND LIMITATIONS Four patients (22%) with suspected major vascular injuries required nephrectomy 1-21 d following the trauma. Two patients with continuing hemorrhage required selective lower-pole arterial embolization (11%). Three patients (17%) had their progressive urinoma drained percutaneously, and two of them required delayed reparative surgery for ureteropelvic junction (UPJ) avulsion. Nine patients (50%) were successfully managed nonoperatively. Kidneys were salvaged in 78% of patients. DMSA scanning showed a split function >40% in 44% of evaluated kidneys. Two patients (22%) had split function <30%. At last follow-up, none of the children were hypertensive or had any abnormality on urine analysis. CONCLUSIONS Nonoperative management of grade 5 renal trauma is feasible. Prompt surgical intervention is required for those with major vascular injuries. Superselective arterial embolization can be an excellent option in patients with continuing hemorrhage and who have pseudoaneurysms. Patients with UPJ disruption can be salvaged by initial drainage of the urinoma followed by deferred correction.
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Affiliation(s)
- Waleed Eassa
- Pediatric Urology Unit, Urology and Nephrology Center, Mansoura, Egypt.
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Hamner CE, Groner JI, Caniano DA, Hayes JR, Kenney BD. Blunt intraabdominal arterial injury in pediatric trauma patients: injury distribution and markers of outcome. J Pediatr Surg 2008; 43:916-23. [PMID: 18485966 DOI: 10.1016/j.jpedsurg.2007.12.039] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Accepted: 12/03/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND The epidemiology of pediatric blunt intraabdominal arterial injury is ill defined. We analyzed a multiinstitutional trauma database to better define injury patterns and predictors of outcome. METHODS The American College of Surgeons National Trauma Database was evaluated for all patients younger than 16 years with blunt intraabdominal arterial injury from 2000 to 2004. Injury distribution, operative treatment, and variables associated with mortality were considered. RESULTS One hundred twelve intraabdominal arterial injuries were identified in 103 pediatric blunt trauma patients. Single arterial injury (92.2%) occurred most frequently: renal (36.9%), mesenteric (24.3%), and iliac (23.3%). Associated injuries were present in 96.1% of patients (abdominal visceral, 75.7%; major extraabdominal skeletal/visceral, 77.7%). Arterial control was obtained operatively (n = 46, 44.7%) or by endovascular means (n = 6, 5.8%) in 52 patients. Overall mortality was 15.5%. Increased mortality was associated with multiple arterial injuries (P = .049), intraabdominal venous injury (P = .011), head injury (P = .05), Glasgow Coma Score less than 8 (P < .001), cardiac arrest (P < .001), profound base deficit (P = .007), and poor performance on multiple injured outcomes scoring systems (Revised Trauma Score [P < .001], Injury Severity Score [P = .001], and TRISS [P = .002]). CONCLUSION Blunt intraabdominal arterial injury in children usually affects a single vessel. Associated injuries appear to be nearly universal. The high mortality rate is influenced by serious associated injuries and is reflected by overall injury severity scores.
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Affiliation(s)
- Chad E Hamner
- Division of Pediatric General Surgery, Schneider Children's Hospital, New Hyde Park, NY 11040, USA
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Salem HK, Morsi HAA, Zakaria A. Management of high-grade renal injuries in children after blunt abdominal trauma: experience of 40 cases. J Pediatr Urol 2007; 3:223-9. [PMID: 18947740 DOI: 10.1016/j.jpurol.2006.07.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2006] [Accepted: 07/20/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We present our experience of management of high-grade renal trauma in a pediatric population, including assessment of the long-term function and morphology of the ipsilateral kidney. PATIENTS AND METHODS From 1997 to 2005, 40 children with high-grade renal injury (III, IV, V) after blunt abdominal trauma were managed. Initial evaluation included vital signs, color of urine, hemoglobin (Hb%), hematocrit, serum creatinine and computed tomography (CT). Follow up included vital signs, urine analysis, Hb%, CT, +/-intravenous pyelogram and renogram. RESULTS One patient needed superselective embolization due to continuing hemorrhage in spite of conservative treatment. Internal stenting plus percutaneous tube drain was indicated in three cases due to progressive extravasation. Exploration was indicated in four cases, one at presentation due to hemodynamic instability which ended in nephrectomy; the other three were successfully repaired. Conservative treatment was successful in 32 cases (80%). Blood transfusion was indicated in 16 cases (40%). Length of hospital stay was 4-20 days (mean 12.1). At the last follow up (range 1-8 years, mean 3.5), scars were detected in 10 cases, while all showed normal levels of Hb% and creatinine. No patient developed hypertension. Apart from in the nephrectomy case, the ipsilateral kidney showed split function of 40-50%. CONCLUSION After exclusion of hemodynamic instability and continuing hemorrhage, conservative treatment is successful in 80% of patients. Internal stenting with or without percutaneous drainage is indicated if there is progressive urinoma. Angioembolization is successful in selected cases.
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Affiliation(s)
- Hosni Khairy Salem
- Urology Department, Kasr El-Einy Hospital, French Teaching Hospital, El Mabarra Hospital, Specialized Paediatric Hospital, Cairo University, PO Box 247, Giza, 12515 Cairo, Egypt.
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Goffette PP. Imaging and Intervention in Post-traumatic Complications (Delayed Intervention). Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Novellas S, Chevallier P, Motamedi JP, Kurzenne JY, Berard E, Bruneton JN. Superselective embolization of a post-biopsy renal pseudoaneurysm in a 13-month-old infant. Pediatr Radiol 2006; 36:874-6. [PMID: 16685534 DOI: 10.1007/s00247-006-0195-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2006] [Revised: 03/20/2006] [Accepted: 03/26/2006] [Indexed: 11/28/2022]
Abstract
Renal artery pseudoaneurysms are infrequent and are most often secondary to surgical or percutaneous renal biopsies. Their rupture can cause rapid clinical deterioration by massive haemorrhage. Diagnosis and treatment must, therefore, be rapid. Currently, surgical treatment remains the gold standard in most institutions while paediatric cases of endovascular embolization have seldom been described. We report a 13-month-old infant with a post-biopsy renal pseudoaneurysm successfully treated by selective arterial embolization.
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Affiliation(s)
- Sébastien Novellas
- Radiology Department, Central Regional Hospital and University of Nice, Archet Hospital 2, 151 route de Saint Antoine de Ginestière, B.P. 3079, 06202, Nice Cedex 3, France.
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Lougué-Sorgho LC, Lambot K, Gorincour G, Chaumoître K, Chapuy S, Bourlière-Najean B, Panuel M, Devred P, Petit P. [Kidney trauma in children: state of the art medical imaging]. JOURNAL DE RADIOLOGIE 2006; 87:275-83. [PMID: 16550111 DOI: 10.1016/s0221-0363(06)74001-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Traumatic renal lesions have some particularities in the pediatric age group, especially for anatomic reasons. Imaging is very important for diagnosis and staging. Ultrasonography with Doppler is the first line examination performed in children and frequently allows initial diagnosis. From the Doppler-ultrasonographic results and the type of trauma, renal Computed Tomography (CT) is complementary performed. The association of these imaging techniques allows comprehensive work-up of traumatic renal lesions, and also of associated or pre-existing lesions. Conservative management is the rule in most cases. Interventional imaging techniques are sometimes used for therapeutic care of renal pedicular vascular lesions or lesions of the collecting system. Far from the traumatic event, imaging allows to follow up the morphologic and functional evolution of major renal lesions, in particular lesions of excretory renal ducts.
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Affiliation(s)
- L C Lougué-Sorgho
- Service de Radiologie Pédiatrique, Hôpital Timone Enfants, 264 rue Saint Pierre, 13385 Marseille, Cedex 05
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Abstract
Renal artery pseudoaneurysm is uncommon complication after blunt trauma injury. We report here on a case of delayed bleeding from a renal artery pseudoaneurysm at 21 days after the injury. It was successfully treated by angioembolization despite the fact that the patient was hemodynamically unstable.
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Affiliation(s)
- Dong-Gi Lee
- Department of Urology, School of Medicine, Kyung Hee University, Seoul, Korea
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Saad DF, Gow KW, Redd D, Rausbaum G, Wulkan ML. Renal artery pseudoaneurysm secondary to blunt trauma treated with microcoil embolization. J Pediatr Surg 2005; 40:e65-7. [PMID: 16291147 DOI: 10.1016/j.jpedsurg.2005.07.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Renal artery pseudoaneurysms are rarely described sequelae of blunt abdominal trauma. Interventional radiological advances have allowed such lesions to be managed nonoperatively. METHODS The authors review the presentation, diagnostic evaluation, and hospital course of an 11-year-old girl who developed a right renal artery pseudoaneurysm 14 days after blunt abdominal trauma. RESULTS An 11-year-old girl fell off a horse onto her right flank. She sustained multiple right hepatic lobe lacerations and a complex fracture of the upper pole of the right kidney. Her initial hospital course was uncomplicated, and she was discharged after an uneventful 6-day course. The child did well for 2 weeks, until she developed right back pain and gross hematuria. A computed tomography scan revealed a right renal artery pseudoaneurysm. Angiography confirmed the presence of a pseudoaneurysm, which was fed by a single segmental branch originating from the renal artery. The artery was successfully occluded with a single platinum microcoil, which was demonstrated by the absence of contrast flow into the pseudoaneurysm. The patient recovered and was discharged shortly after the procedure. She initially had intermittent pain and hematuria, which resolved. Follow-up computed tomography scans have shown resolution of both the renal and hepatic lesions. CONCLUSIONS Renal artery pseudoaneurysms that arise after blunt abdominal trauma in the pediatric population may be safely and effectively managed with arterial embolization, thereby avoiding extensive surgical interventions.
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Affiliation(s)
- Daniel F Saad
- The Joseph B. Whitehead Department of Surgery, Division of Pediatric Surgery, Emory University and Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
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El-Sherbiny MT, Aboul-Ghar ME, Hafez AT, Hammad AA, Bazeed MA. Late renal functional and morphological evaluation after non-operative treatment of high-grade renal injuries in children. BJU Int 2004; 93:1053-6. [PMID: 15142163 DOI: 10.1111/j.1464-410x.2004.04780.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the long-term results in children with high-grade renal trauma who were managed without surgery, as such treatment was initially successful but little is known about the late ipsilateral renal function and morphology. PATIENTS AND METHODS The study included 13 children (nine boys and four girls; mean age 8 years, sd 5) with high-grade renal injury who were managed without surgery between 1997 and 2001, and followed for a mean (sd, range) of 3 (2, 0.5-7) years. The trauma was caused by a motor-car accident in five and falling from a height in eight children, and was on the right in 10 and on the left in three. There was gross and microscopic haematuria in 10 and three patients, respectively. The trauma was graded according to the American Association for Surgery of Trauma, with grades III, IV and V renal injury in six, four and three children, respectively. All patients were treated initially by observation; one required super-selective embolization because of continuing haemorrhage. Three children with progressive urinary extravasation were treated with a percutaneous tube drain and JJ stent for 6 weeks. Patients were discharged after a mean (sd) hospital stay of 9 (6) days. Ultrasonography then showed resolving haematoma in all patients with a mean (sd) size of 7 (2) cm(2). At the last follow-up patients were re-evaluated by a clinical examination, renal scintigraphy and computed tomography angiography. RESULTS None of the children was hypertensive nor had any abnormality on urine analysis; all had normal serum creatinine levels, and scintigraphy and angiography showed normal contralateral kidneys in all. Ipsilateral abnormalities were detected in 12 patients, and included a single scar in five, multiple scars in six and a cystic lesion with multiple septa in one. There was no vascular complication or hydronephrosis, and no significant functional loss, with all affected kidneys having a split function of 41-50% at the last follow-up. CONCLUSION Although there is no late functional loss there are residual morphological changes in almost all children with high-grade renal injury. This study provides objective support for the non-operative management of high-grade renal injury in children, but a prolonged follow-up is warranted to assess the risk of progression of these abnormalities.
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Affiliation(s)
- M T El-Sherbiny
- The Mansoura Urology and Nephrology Center, Mansoura, Egypt.
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