A rare case of closed post-traumatic renal section. Review of trauma mechanisms and case report

Abstract

The kidney is one of the most vulnerable abdominal organs in blunt trauma, particularly in high-energy impacts involving acceleration-deceleration mechanisms. It is estimated that 1 in 10 blunt trauma cases involves renal injury. Studies by Mansbridge et al. and Schoodridge et al. identified a higher incidence in adult males, a trend confirmed in the pediatric population by Alsaywid et al. The most frequent causes in adults—according to Velzke—are traffic accidents, falls, and sports injuries, etiologies similarly reported in children. The clinical presentation is characterized by hematuria, pain, and renal hematoma in at least 80% of cases. Although current management tends toward a conservative approach, injuries with severe compromise of renal architecture require surgical resolution as definitive treatment. We report the case of a male patient with no relevant medical history, admitted to the emergency department of a secondary-level hospital following a motorcycle accident in which he was the rider. He presented with abdominal pain, hematuria, and thoracoabdominal wall trauma. Imaging studies revealed severe renal injury, hemoperitoneum, and an open fracture of the right tibia and fibula. Emergency laparotomy confirmed complete avulsion of the right kidney, with separation into upper and lower segments and loss of vascular continuity, leading to right nephrectomy and surgical washout of the hemoperitoneum. In the ICU, the patient evolved with hemodynamic instability, vasopressor requirement, mechanical ventilation, mixed acidosis, leukocytosis, acute kidney injury, and rhabdomyolysis. He was transferred to another facility for management of the fracture, still under ventilatory and vasopressor support. Sedoanalgesia was progressively reduced, and spontaneous ventilation without vasopressors was achieved. On day 11, external fixation of the fracture was performed; the patient declined definitive corrective surgery and requested voluntary discharge on day 12.