blunt injury abdomen(renal trauma&mesenteric trauma)

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BLUNT INJURY ABDOMENINJURIES TO KIDNEY

- Dr. Vinay kumar Pokala

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• Commonly it is due to a blunt injury.• Often it is associated with other abdominal injuries- of

liver,spleen,bowel,mesentry,etc.

• Clinical features• Features of shock• Haematuria-may be mild to profuse depending on

the type of injury.• Sudden delayed profuse haemorrhage causing

haematuria can occur between 3rd day to 3rd week after trauma.

• Clot colic;bruising,swelling and tenderness in the loin.

RENAL TRAUMA

RENAL TRAUMA

TYPESA. Small subcapsularB. Large subcapsularC. Cortical lacerationD. Laceration with perinephric

haematomaE. Medullary lacerationF. Corticomedullary complete

ruptureG. Hilar injury (most dangerous)

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• Grading of renal injury1) Subcapsular non expanding haematoma.2) Cortical laceration < 1cm of parenchymal

depth.3) Cortical laceration > 1cm of depth.4) Parenchymal laceration extending through

cortex and medulla with collecting system.5) Renal pedicle avulsion;shattered kidney.

RENAL TRAUMA

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• INVESTIGATIONS• IVU (high dose)• U/S abdomen• Blood urea and serum creatinine should be

repeated at regular intervals.• Blood grouping and cross-matching for blood

transfusion.• Emergency CT scan.

RENAL TRAUMA

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RENAL TRAUMA

Kidney trauma. Grade 1 renal injury, contusion. Image from a contrast-enhanced CT scan of the abdomen in a patient with hematuria after a motor vehicle collision shows ill-defined area of hypoenhancement in the medial right kidney.

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• TREATMENTI. Initially always conservative: -

catheterise & watch the urine colour and output. -blood transfusion -regular monitoring of the pulse,BP,temperature,U/S follow-up daily. -sedation,analgesic,antibiotics. -75% of patients respond to conservative management.

RENAL TRAUMA

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ii). Indications for surgical intervention -when there are signs of progressive blood loss with the condition of the patient deteriorating. -formation of progressive perinephric haematoma.

-when there are associated other injuries. -hilar injury.

RENAL TRAUMA

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• SURGERY (Only 10-20% of Patients)• Gentle suturing of the laceration.often

kidney is friable,this is not possible.• When the injury in the poles partial

nephrectomy is done.• In hilar injury and severe laceration,

nephrectomy is the only choice.

RENAL TRAUMA

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RENAL TRAUMA

• COMPLICATIONS• Clot retention in the bladder and may go for

renal failure.• Pararenal pseudohydronephrosis.• Perinephric abscess.• Aneurysm of renal artery.• Hypertension occurs 3 months later.

BLUNT INJURY ABDOMENMESENTERIC TRAUMA

- Dr. Vinay kumar

MESENTERIC TRAUMA

• It is commonly seen in blunt abdominal trauma.• Traction injury or seat belt injury causes mesenteric

tear.

• PRESENTATIONS• Features of haemoperitoneum-

shock,pallor,abdominal distension and pain,guarding and rigidity.

MESENTERIC TRAUMA

HAEMOPERITONEUM

MESENTERIC TRAUMA

• Types• 1) transverse tear in mesentry causes not only

more bleeding but also causes adjacent bowel ischaemia.laparotomy & resection of bowel is needed.

• 2) longitudinal tear can be sutured using interrupted absorbable sutures after haemostasis.

MESENTERIC TRAUMA

• INVESTIGATIONS• Ultra sound abdomen.• Diagnostic peritoneal lavage.• CT abdomen.• Haematocrit,electrolyte estimation,blood

grouping.

MESENTERIC TRAUMA

CECT scan showing mesenteric haematoma

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MESENTERIC TRAUMA

• TREATMENT• Emergency laparotomy and

resection of bowel or suturing of the mesentry.

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THANK YOU …