Kurniawan Andri, Adi Kuncoro
Department of Urology, Faculty of Medicine University of Padjadjaran, Hasan Sadikin Hospital Bandung, Bandung, West Java, Indonesia.
Department of Urology, Faculty of Medicine University of Padjadjaran, Hasan Sadikin Hospital Bandung, Bandung, West Java, Indonesia.
Int J Surg Case Rep. 2022 May;94:107005. doi: 10.1016/j.ijscr.2022.107005. Epub 2022 Mar 30.
Kidneys are one of the most commonly affected retroperitoneal organ in trauma cases despite its relatively well-protected location. Renal trauma occurs in 80-95% of urogenital trauma cases and 8-10% of abdominal blunt trauma. Renal trauma in hydronephrotic kidney due to ureteropelvic junction obstruction (UPJO) is a rare entity, despite of high risk of trauma urogenital due to large size and thin parenchyma. In this case we reported blunt renal injury with a congenital abnormality of the kidney.
We present a case of abdominal blunt trauma due to motor-vehicle accident in a 23 year old male patient. The patient complaint of visible hematuria since 1 day after falling from motorcycle with right flank hit the road, accompanied with right flank pain. Vital signs were within normal limits. Physical examinations reveal distention of right flank with no sign of peritonitis. Supporting examination with FAST ultrasound revealed grade 4 hydronephrosis with internal echo, suspected blood accumulation inside the kidney. Abdominal CT scan revealed grade IV hydronephrosis of right kidney with thin parenchyma. We performed laparotomy and renal exploration, intraoperatively we found multiple laceration of the kidney into pelvicalyceal system (AAST grade IV) with hematoma inside the right kidney and UPJ stenosis (about 5 cm). We decided to perform right nephrectomy despite of grade IV injury with consideration of poor renal function, long stenosis segment and thin renal parenchyma will cause many complications in the future for the patient.
Renal injury in UPJO kidney is a rare entity despite of high risk of injury in this population. Management of renal injury in this population might be not consistent with guideline for renal trauma, and clinical judgement from the physician plays an important role to provide the best treatment for this patient.
肾脏是创伤病例中最常受影响的腹膜后器官之一，尽管其位置相对受到较好的保护。肾外伤发生在80%-95%的泌尿生殖系统创伤病例中，以及8%-10%的腹部钝性创伤中。尽管由于肾盂输尿管连接部梗阻（UPJO）导致肾积水的肾脏因体积大且肾实质薄而存在泌尿生殖系统创伤的高风险，但肾积水性肾脏的肾外伤是一种罕见的情况。在此病例中，我们报告了一例伴有先天性肾脏异常的钝性肾损伤。
我们呈现了一名23岁男性患者因机动车事故导致腹部钝性创伤的病例。患者自从骑摩托车摔倒后右侧腹部撞到路面1天后出现肉眼血尿，并伴有右侧腹部疼痛。生命体征在正常范围内。体格检查发现右侧腹部膨隆，无腹膜炎体征。FAST超声辅助检查显示4级肾积水伴内部回声，怀疑肾内有血液积聚。腹部CT扫描显示右肾IV级肾积水，肾实质薄。我们进行了剖腹探查和肾脏探查，术中发现肾脏有多处裂伤延伸至肾盂肾盏系统（美国创伤外科学会IV级），右肾内有血肿，且肾盂输尿管连接部狭窄（约5厘米）。尽管损伤为IV级，但考虑到肾功能差、狭窄段长以及肾实质薄将来会给患者带来许多并发症，我们决定进行右肾切除术。
尽管UPJO肾脏受伤风险高，但UPJO肾脏的肾损伤是一种罕见情况。该人群肾损伤的处理可能与肾外伤指南不一致，医生的临床判断对于为该患者提供最佳治疗起着重要作用。
