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Reno-Vascular Hematoma

  • Caused by either thrombosis of small vessel (All renal vessels are end artery), or by engulfment of vessel in posttraumatic fibrosis.
  1. Symptoms:
    1. Abdominal pain usually localized to one flank.
    2. Hematuria.
    3. Retroperitoneal bleed may cause peritonism, ileus & distention (Meteorism – usually 24 – 48 hr after renal injury), Nausea and vomiting.
    4. Degree of hematuria does not correlate to the degree of renal injury.
  2. Signs:
    1. Patient may present in shock in massive bleed.
    2. Bruise, echymosis, lump, or lower rib fracture.
    3. Features of peritonitis.
  3. Laboratory Findings: Microscopic or gross hematuria.
    Indications for IVP:
    1. All patient with gross hematuria.
    2. All patients with microscopic hematuria with shock.
    3. Gross hematuria with normal IVP requires no additional test.
    4. Nonvisualiztion requires immediate CT scan.
    5. IVP also functions as plain x-ray as far as Gas under diaphragm or bone fractures are to be seen
    6. Arteriography defines vascular and major parenchymal damage, thrombus and avulsion.
    7. CECT: Is investigation of choice in stable patient.
    8. It is useful for grading for renal trauma, function of the opposite kidney and associated other abdominal injury.
    9. In unstable patient of renal trauma contrast agent add in resuscitation fluid and take single x-ray in OT before exploratory laprotomy. Q
  5. Treatment
    Emergency Measures: ABC
    1. CONSERVATIVE MEASURES (Non operative management):
      1. In 90% of renal injuries conservative measure is treatment of choice if vital of the patient is stable.
      2. This includes, IV fluids/ blood, antibiotics, bed rest, sedatives, regular urinalysis and strict vitals monitoring.
    2. Surgical Measures:
      1. Absolute indication of surgery:
        • Expending perirenal hematoma
        • Persistent haemorrhage leading to shock.
      2. Nephrectomy, Partial nephrectomy and repair of laceration are the main surgical procedures done in cases of renal trauma.
    3. Treatment Of Complications:
      1. Retroperitoneal urinoma or perinephric abscess requires immediate surgical drainage.
      2. Malignant hypertension requires vascular surgery, endo-vascular dilatation or nephrectomy.
      3. Hydronephrosis in a functioning kidney requires repair and in non-functioning kidney nephrectomy can be done.
A 55 yr old man presents with complain of painless hematuria with passage of blood clots in urine intermittently for past 5 years. Recently he had 5 episodes lasting for 4 – 5 days. Which of the following investigation would yield most to arrive at diagnosis? (AIPG 2011)
A. X-ray KUB                                                                        
B. Abdominal ultrasound   
C. Urine examination and microscopy                           
D. DTPA scan
Ans. C. Urine examination and microscopy

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