Department of Uro-Visceral and Genital Paediatric Surgery, Mohammed VI University Hospital, Oujda, Morocco.
Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco.
Pan Afr Med J. 2022 Apr 29;41:347. doi: 10.11604/pamj.2022.41.347.31945. eCollection 2022.
blunt renal traumas in children are rare and their management is not suited to a very clear consensus. We sought to report our experience in managing renal injuries in children presented after blunt abdominal trauma.
data of children aged less than 16 years with blunt renal injuries between January 2015 and April 2021 were retrospectively reviewed. Demographic characteristics, clinical course, biological results, radiological findings, associated injuries, management and follow up of included patients were described. Renal lesions were classified according to the American Association for the Surgery of Trauma (AAST).
we included a total of 20 children, of whom 70% (n=14) were males. The mean of age was 8.50 ± 3.42 years. Falls in 65% (n=13) and motor-vehicle accidents in 35% (n=7) were the two main mechanisms of injuries. Abdominal pain was the most common symptom and macroscopic hematuria was assessed in 55% of patients (n=11). Low-grade injuries (I-III) represented 40% of the cases (n=8), 60% of injuries were AAST grade IV (n=12) and none with AAST grade V was diagnosed. Spleen injuries in 25% (n=5) as well as traumatic brain injuries in 25% (n=5) were the most identified concomitant injuries followed by liver lesions in 15% (n=3). 75% of renal injuries (n=15) were managed conservatively and all cases that required an operative management were with AAST grade IV. No nephrectomy in our series was performed and the follow up was favorable with a median of 3 years.
our data suggest that the majority of children with blunt renal injuries can be managed conservatively regardless the grade of lesions as long as no hemodynamic instability or symptomatic urinoma are identified.
儿童钝性肾损伤较为罕见，其处理方法尚无明确共识。本研究旨在报告我们在处理儿童钝性腹部创伤后出现的肾损伤方面的经验。
回顾性分析 2015 年 1 月至 2021 年 4 月期间收治的年龄小于 16 岁的儿童钝性肾损伤患者的数据。描述了纳入患者的人口统计学特征、临床病程、生物学结果、影像学发现、合并损伤、处理和随访情况。肾损伤按美国外科创伤协会（AAST）分类。
共纳入 20 例患儿，其中 70%（n=14）为男性，平均年龄为 8.50±3.42 岁。65%（n=13）的损伤机制为跌倒，35%（n=7）为机动车事故。腹痛是最常见的症状，55%（n=11）的患者有肉眼血尿。低级别损伤（I-III 级）占 40%（n=8），60%（n=12）的损伤为 AAST 分级 IV 级，无一例诊断为 AAST 分级 V 级。25%（n=5）的患者合并脾损伤，25%（n=5）的患者合并创伤性脑损伤，其次是肝损伤（15%，n=3）。75%（n=15）的肾损伤采用保守治疗，所有需要手术治疗的病例均为 AAST 分级 IV 级。本系列中未行肾切除术，中位随访 3 年，结果良好。
我们的数据表明，大多数儿童的钝性肾损伤可以保守治疗，无论损伤程度如何，只要没有血流动力学不稳定或症状性尿囊肿。
