Management of blunt renal trauma in a tertiary hospital of south India: a retrospective single centre study

Background: Blunt renal trauma are usually caused by high-energy collisions such as road traffic accidents (RTA), fall from a height. They occur in 5 to 10 % of all trauma. Majority of hemodynamically stable patients with blunt renal trauma are successfully managed non operatively. Aims and Objective: To review the management of blunt renal trauma in our centre. Materials and Methods: A retrospective study of 22 patients was carried out in JSS Medical College and Hospital from January 2017 to January 2019. All blunt renal injuries were graded according to American Association for the Surgery of Trauma (AAST) organ injury severity scale. The following data were collected: demographics, mechanism of injury, associated injuries, admission hemoglobin, blood transfusion, CT findings, renal injury grade, presence of other organ injuries on CT scan, type of management, indication for operative intervention, operative procedures, operative findings, any other interventions required, hospital stay, morbidity, and mortality. Results: There were 22 renal injuries. Majority of them had Road Traffic Accidents and assault. Grade 2-3 were most common in 12 cases followed by grade 1 in five cases, grade 4 in three cases and finally grade 5 renal injury was seen in three cases. Three grade 5 injuries and two Grade 4 needed exploration for hemodynamic unstability and underwent emergency nephrectomy otherwise all cases were managed successful nonoperatively. There was no mortality due to blunt renal trauma. Conclusion: Conservative management of blunt renal trauma without associated abdominal injury is feasible in patients who are hemodynamically stable at presentation. Advancements in imaging techniques and improved critical care have favoured the conservative approach for even the severe grade of injuries.