Pre-existing renal lesions revealed after renal trauma, Difficulties in diagnosis and accountability: About 14 cases

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Published Aug 17, 2016
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Vol. 94 No. 3 (2016): Issue Mar 2016

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Sataa Sallami
Mohamed Mongi Mighri
Mahmoud Benatta
Hassen Khouni
Sana Abou El Makarim
Mohamed Allouch
Hassen Touinsi

Abstract

Abstract:


OBJECTIVE:
Pre-existing renal lesions (PERL) may interfere with the patho-physiology of trauma, alter the radiographic imaging and influence the therapeutic approach.
The aims of this study were to record the PERL found incidentally during blunt renal trauma, to specify the place for effective conservative management and to determin the estimated partial permanent disability (PPD).

PATIENTS AND METHODS:
The medical records of 14 patients with PERL and blunt renal trauma were reviewed. In each patient, pre-existing renal abnormalities, clinical symptoms, CT scan study findings, associated injuries, therapeutic approach, the accountability criteria and the estimated PPD were recorded.

RESULTS:
There were 11 men and 3 women with a mean age of 35,6 years (range 19-66 years).
Renal trauma was due to a traffic accident in 8 patients.
Renal damage appeared to be disproportionate to the severity of the trauma (minor trauma). They had a lower rate of associated trauma to other abdominal organs (four patients only).
Urinary stones were present in 5 patients, pelvi-ureteric junction obstruction in 3, horseshoe kidny in 3, ectopic kidney in 2 and upper urinary tract carcinoma in one case.
Early nephrectomy was required in three cases for hemodynamic instability. Ureteral stenting was indicated in 3 cases. Six patients were operated later because of their underlying renal pathology. A conservative treatment was possible only in 7 of cases.
The PPD related to renal trauma varide from 0 to 13% in all cases.

CONCLUSION:
PERL may complicate a negligible renal trauma while in some cases they may be of vital importance for the patient's final outcome. The imaging findings are crucial but may be confusing. The therapeutic approach is, to a large extent, dependent on the type of PERL and the severity of damage, and is often conservative in the hemo-dynamically stable patient.
Accountability link may be difficult to establish and the PPD depends on the PERL and the renal injuries severity.

Funding: We have no involvement with funding in this case.
Ethical approval: Not required
Conflicts of interest: None

Keywords:

Kidney, Renal trauma, Congenital anomaly, Adult, Computed tomography, Accountability, Permanent partial disability.

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