[Selective embolization in the treatment of severe renal injury].

OBJECTIVES

We report a new case of severe renal trauma with significant active bleeding and urinary tract lesion in a hemodynamically stable patient, emphasizing the option of conservative treatment with selective embolization of the bleeding segmentary renal arteries, and stenting of the urinary tract with retrograde insertion of a JJ stent; thus avoiding emergency surgery associated with a high risk of nephrectomy. We review the indications of this therapeutic option.

METHODS

Embolization of bleeding segmentary renal arteries and retrograde insertion of a JJ stent in a 24 year old patient presenting with severe renal trauma after motorbike motor vehicular accident. Patient remained hemodynamically stable during the whole diagnostic and therapeutic process. Good clinical outcome after 72 hours of ICU control and 18 days of admission in the Urology ward.

RESULTS

After selective embolization bleeding stopped immediately; significative hematoma resorption and urinary fluid collection disappearance was seen during a 3 week hospital admission. There were not either immediate or deferred complications, being both renal function and blood pressure normal after 18 months follow up.

CONCLUSION

Embolization of the bleeding segmentary renal arteries after severe renal trauma in hemodynamically stable patients is a therapeutic option that allows avoiding emergency surgery, which is associated with high risk for nephrectomy. Urinary tract stenting is enough for a good outcome of the pyelocalicilar system.