PURPOSE: We developed criteria for nonoperative treatment of penetrating renal injuries and predicting which patients will benefit from immediate surgery. MATERIALS AND METHODS: We reviewed the records of 120 patients with grades 2 to 4 renal lacerations from gunshot and stab wounds, of whom 41 were treated nonoperatively (group 1) and 79 underwent immediate renal exploration (group 2). RESULTS: Group 1 had significantly lower incidences of gunshot wounds, shock, associated injuries, need for transfusion and high grade renal injuries. In patients with grade 2 lacerations no complications resulted from nonoperative treatment. However, 23.5% of patients in group 1 with grades 3 and 4 injuries had delayed renal bleeding versus none in group 2. CONCLUSIONS: Nonoperative treatment of penetrating renal lacerations is appropriate in hemodynamically stable patients without associated injuries. Grade 2 injuries can be treated nonoperatively but grades 3 and 4 injuries are associated with a significant risk of delayed bleeding if treated expectantly. Exploration should be considered if laparotomy is indicated for other injuries.
PURPOSE: We developed criteria for nonoperative treatment of penetrating renal injuries and predicting which patients will benefit from immediate surgery. MATERIALS AND METHODS: We reviewed the records of 120 patients with grades 2 to 4 renal lacerations from gunshot and stab wounds, of whom 41 were treated nonoperatively (group 1) and 79 underwent immediate renal exploration (group 2). RESULTS: Group 1 had significantly lower incidences of gunshot wounds, shock, associated injuries, need for transfusion and high grade renal injuries. In patients with grade 2 lacerations no complications resulted from nonoperative treatment. However, 23.5% of patients in group 1 with grades 3 and 4 injuries had delayed renal bleeding versus none in group 2. CONCLUSIONS: Nonoperative treatment of penetrating renal lacerations is appropriate in hemodynamically stable patients without associated injuries. Grade 2 injuries can be treated nonoperatively but grades 3 and 4 injuries are associated with a significant risk of delayed bleeding if treated expectantly. Exploration should be considered if laparotomy is indicated for other injuries.
Authors: M Heuer; B Hussmann; M Schenck; D Nast-Kolb; S Ruchholtz; R Lefering; A Paul; G Taeger; S Lendemans Journal: Unfallchirurg Date: 2012-08 Impact factor: 1.000
Authors: M T Muir; K Inaba; A Ong; G Barmparas; B C Branco; E A Zubowicz; M Salhanick; S M Cohn Journal: Eur J Trauma Emerg Surg Date: 2011-10-05 Impact factor: 3.693