DO WE NEED TO OPERATE IN POST-TRAUMATIC RENAL TRANSECTION WITH BLEEDING? PATIENT COMES TO HER OWN AID IN SOLVING THE DILEMMA – A CASE REPORT

Deepak David*, Vasudevan Thirugnanasambandam, Kalyanaram Kone, Joseph Philipraj, Brahadeeswaran Subbaiyan and Mossadeq Abdulrazak

ABSTRACT

High-grade renal injury occurs predominantly in pediatric population when compared to adults. Non-operative management is advocated in stable patients irrespective of the grade of injury and intervention is recommended in unstable patients. Children presenting with active bleeding are a source of treatment dilemma because of the limited amount of circulating blood volume and the ease with which they can go in to shock with a small amount of blood loss. Here, we report a 9-year-old girl who on evaluation following blunt trauma was found to have complete transection of the upper pole of right kidney with large perinephric hematoma. She was initially managed conservatively, but the plan changed to intervention on the 2nd day because of significant hemoglobin drop and hypotension. Renal Angiography was done before surgical procedure to see for the feasibility of minimal intervention procedure. It revealed active bleeding from an accessory upper polar renal artery, and we then proceeded with selective embolization of the accessory upper polar artery. Patients own vascular anomaly helped us solving the dilemma as embolization could be done without significant risk of migration. Following embolization, the bleeding stopped and she had an uneventful recovery. This case highlights the need of using minimal intervention procedures before resorting to surgery in post-traumatic renal injuries and treating these patients in tertiary care centres where all the facilities are available.

Keywords: High grade renal injury, complete transection of upper pole, renal angiography, selective angioembolization of accessory upper polar artery.