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Non-Operative Management with Angioembolization of Grade IV and V Renal Injuries in a Hybrid Emergency Room System

  • Ahn, So Ra (Department of Trauma Surgery, Wonkwang University Hospital Regional Trauma Center) ;
  • Seo, Sang Hyun (Department of Radiology, Wonkwang University Hospital Regional Trauma Center) ;
  • Lee, Joo Hyun (Department of Trauma Surgery, Wonkwang University Hospital Regional Trauma Center) ;
  • Park, Chan Yong (Division of Trauma Surgery, Department of Surgery, Seoul National University Hospital)
  • Received : 2021.05.03
  • Accepted : 2021.06.28
  • Published : 2021.09.30

Abstract

Renal injuries occur in more than 10% of patients who sustain blunt abdominal injuries. Non-operative management (NOM) is the established treatment strategy for lowgrade (I-III) renal injuries. However, despite some evidence that NOM can be successfully applied to high-grade (IV, V) renal injuries, it remains unclear whether NOM is appropriate in such cases. The authors report two cases of high-grade renal injuries that underwent NOM after embolization in a hybrid emergency room (ER) system with a 24/7 in-house interventional radiology (IR) team. A 29-year-old male visited Wonkwang University Hospital Regional Trauma Center complaining of right abdominal pain after being hit by a rope. Computed tomography (CT) was performed 16 minutes after arrival, and the CT scan indicated a grade V right renal injury. Arterial embolization was initiated within 31 minutes of presentation. A 56-year-old male was transferred to Wonkwang University Hospital Regional Trauma Center with a complaint of right flank pain. He had initially presented to a nearby hospital after falling from a 3-m height. Thanks to the key CT images sent from the previous hospital prior to the patient's arrival, angiography was performed within 8 minutes of the patient's arrival and arterial embolization was completed within 25 minutes. Both patients were treated successfully through NOM with angioembolization and preserved kidneys. Hematoma in the first patient and urinoma in the second patient resolved with percutaneous catheter drainage. The authors believe that the hybrid ER system with an in-house IR team could contribute to NOM and kidney preservation even in high-grade renal injuries.

Keywords

References

  1. van der Wilden GM, Velmahos GC, Joseph DK, Jacobs L, Debusk MG, Adams CA, et al. Successful nonoperative management of the most severe blunt renal injuries: a multicenter study of the research consortium of New England Centers for Trauma. JAMA Surg 2013;148:924-31. https://doi.org/10.1001/jamasurg.2013.2747
  2. Chouhan JD, Winer AG, Johnson C, Weiss JP, Hyacinthe LM. Contemporary evaluation and management of renal trauma. Can J Urol 2016;23:8191-7.
  3. Santucci RA, McAninch JW. Diagnosis and management of renal trauma: past, present, and future. J Am Coll Surg 2000;191:443-51. https://doi.org/10.1016/S1072-7515(00)00695-5
  4. Moore EE, Shackford SR, Pachter HL, McAninch JW, Browner BD, Champion HR, et al. Organ injury scaling: spleen, liver, and kidney. J Trauma 1989;29:1664-6. https://doi.org/10.1097/00005373-198912000-00013
  5. Chien LC, Vakil M, Nguyen J, Chahine A, Archer-Arroyo K, Hanna TN, et al. The American Association for the Surgery of Trauma Organ Injury Scale 2018 update for computed tomography-based grading of renal trauma: a primer for the emergency radiologist. Emerg Radiol 2020;27:63-73. https://doi.org/10.1007/s10140-019-01721-z
  6. Kozar RA, Crandall M, Shanmuganathan K, Zarzaur BL, Coburn M, Cribari C, et al. Organ injury scaling 2018 update: spleen, liver, and kidney. J Trauma Acute Care Surg 2018;85:1119-22. https://doi.org/10.1097/TA.0000000000002058
  7. Santucci RA, Wessells H, Bartsch G, Descotes J, Heyns CF, McAninch JW, et al. Evaluation and management of renal injuries: consensus statement of the renal trauma subcommittee. BJU Int 2004;93:937-54. https://doi.org/10.1111/j.1464-4096.2004.04820.x
  8. Hosein M, Paskar D, Kodama R, Ditkofsky N. Coming together: a review of the American Association for the surgery of trauma's updated kidney injury scale to facilitate multidisciplinary management. AJR Am J Roentgenol 2019;213:1091-1099. https://doi.org/10.2214/AJR.19.21486
  9. Kuan JK, Wright JL, Nathens AB, Rivara FP, Wessells H; American Association for the Surgery of Trauma. American Association for the surgery of trauma organ injury scale for kidney injuries predicts nephrectomy, dialysis, and death in patients with blunt injury and nephrectomy for penetrating injuries. J Trauma 2006;60:351-6. https://doi.org/10.1097/01.ta.0000202509.32188.72
  10. Salem MS, Urry RJ, Kong VY, Clarke DL, Bruce J, Laing GL. Traumatic renal injury: five-year experience at a major trauma centre in South Africa. Injury 2020;51:39-44. https://doi.org/10.1016/j.injury.2019.10.034
  11. Vozianov S, Sabadash M, Shulyak A. Experience of renal artery embolization in patients with blunt kidney trauma. Cent European J Urol 2015;68:471-7. https://doi.org/10.1016/j.eururo.2014.10.024
  12. McClung CD, Hotaling JM, Wang J, Wessells H, Voelzke BB. Contemporary trends in the immediate surgical management of renal trauma using a national database. J Trauma Acute Care Surg 2013;75:602-6. https://doi.org/10.1097/TA.0b013e3182a53ac2
  13. Altman AL, Haas C, Dinchman KH, Spirnak JP. Selective nonoperative management of blunt grade 5 renal injury. J Urol 2000;164:27-30; discussion 30-1. https://doi.org/10.1016/S0022-5347(05)67441-1
  14. Breyer BN, McAninch JW, Elliott SP, Master VA. Minimally invasive endovascular techniques to treat acute renal hemorrhage. J Urol 2008;179:2248-52; discussion 2253. https://doi.org/10.1016/j.juro.2008.01.104
  15. Starnes M, Demetriades D, Hadjizacharia P, Inaba K, Best C, Chan L. Complications following renal trauma. Arch Surg 2010;145:377-81; discussion 381-2. https://doi.org/10.1001/archsurg.2010.30
  16. Lee YJ, Oh SN, Rha SE, Byun JY. Renal trauma. Radiol Clin North Am 2007;45:581-92. https://doi.org/10.1016/j.rcl.2007.04.004
  17. Yao YL, Gao Y. Present situation and research progress of kidney function recoverability evaluation of acute kidney injury patient. Int J Gen Med 2021;14:1919-25. https://doi.org/10.2147/IJGM.S303348