Martínez JÁ, Osornio-Sánchez V, Camacho-Castro AJ, Morales-Montor JG, Cantellano-Orozco M, Pacheco-Gahbler C

Language: Spanish
References: 8
Page: 88-92
PDF size: 360.98 Kb.

ABSTRACT

Traumatic injury is the most common type of kidney lesion. Blunt injuries are caused by automobile accidents, falls, and injuries sustained in fistfights. Penetrating trauma is produced by gunshot or stab wounds. Renal injury is staged according to the American Association for the Surgery of Trauma scale.
Evaluation of the patient with penetrating trauma should focus on rapid identification and care of life-threatening injury. Traumatism rarely causes death, except in the case of renal avulsion or important renal vein or renal artery injury.
The case of a 19-year-old man with left nephrectomy due to kidney injury five years before is presented. He was attacked again, resulting in a stab wound in the right thoracolumbar region. Upon hospital admittance, he presented with hypovolemic shock with 100% right hemothorax and contained perirenal hematoma. Evidence of contrast medium leakage was seen in the arterial phase of a computed tomography scan. An intrapleural catheter was placed, obtaining 1030 cc of bright red blood. Right posterolateral thoracotomy was performed, obtaining 1600 cc of blood with no sign of injury in the pulmonary parenchyma or diaphragm. Intercostal artery injury and seventh costal arch fracture were identified. The patient presented with hemodynamic instability twenty-four hours later; exploratory laparotomy was carried out that revealed a hemoperitoneum with 2000 cc and partial amputation of the upper pole at the posterior surface of the right kidney with active bleeding from the anterior apical artery. The apical artery was tied and the upper pole was sutured. The postoperative progression of the patient was satisfactory.

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