Conservative management of blunt major renal lacerations: risk factors versus the short-term and long-term complications

Choi, Ho Cheol; Park, Choal Hee; Kim, Kwang Sae; Lee, Sung Choon

Abstract

Management of all but the minor forms of renal injury caused by blunt trauma is still somewhat controversial. A generally aggressive early operative approach is advocated in some centers, while a more watchful conservative approach is endorsed in others. In a review of 66 patients with blunt major renal lacerations. 16 patients(24%) could not be stabilized and they subsequently underwent emergency laparotomy. Remaining 50 patients who sustained a renal laceration extending through the corticomedullary junction following blunt trauma underwent an attempt at conservative management. Two major categories existed among these 50 patients: (1)18 patients with devascularized renal fragments(avascular group) and (2) 32 in whom a fragment of the kidney was vascularized (vascular group). Complication accounted for 83 percent of the avascular group and vascular group for 25 percent. The delayed nephrectomy rate with avascular group was markedly higher than reported in vascular group(72 percent in avascular group. none in vascular group) We conclude that non-operative management of major renal lacerations associated with vascularized fragments is a proper method of treatment. However, early surgical intervention should be considered in patients with major renal laceration associated with devascularized fragment due to high complication rate and delayed surgical intervention rate.