Challenges in the diagnosis of severe renal trauma in child: A case report and literature review

Article type: Research Article

Authors: Zhang, Zejian^{a; 1; *} | Zhang, Yixiang^{b; 1} | Wang, Xisheng^{a; 2} | Fang, Liekui^{c; 2} | Chen, Dong^a | Peng, Naixiong^a | Thakker, Parth^d | Wang, Qinjun^a | Zhang, Yuanyuan^{e; 2}

Affiliations: [a] Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China | [b] Department of Urology, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong Province, China | [c] Urinary Surgery Department of the Second Affiliated Hospital of Southern University of Scienceand Technology, Shenzhen third people’s hospital, Shenzhen, Guangdong Province, China | [d] Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA | [e] Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA

Correspondence: [] Corresponding author: Zejian Zhang, E-mail: 185029245@qq.com.

Note: [1] These authors contributed equally to this work.

Note: [2] Co-corresponding authors: Xisheng Wang, E-mail: 18923877315@163.com; Liekui Fang, E-mail: fangliekui88@163.com; Yuanyuan Zhang, E-mail: yzhang@wakehealth.edu.

Abstract: INTRODUCTION:To report the management and outcome of one case of pediatric patient sustaining high-grade blunt renal trauma. We present and discuss the clinical characteristics and radiologic features of the patient. PATIENTS AND METHODS:A 10 years old child was admitted for serious blunt renal trauma formed a huge urinoma in the right renal after injury gradually in 2018. We treated the patient with synchronous percutaneous nephrostomy drainage and retrograde ureteral catheterization. A retrospective review was performed of this case, including the clinical features, imaging studies and short-term follow-up. A literature review was also performed to highlight the principals of diagnosis and treatment of severe blunt renal trauma in children. RESULTS:After drainage, the symptoms of abdominal distension gradually disappeared, and the physical examination shows that the abdomen gradually reduced to normal. The huge urinoma was cured by synchronous drainge. No complications occurred in short-term follow-up. COMMENTS:The choice of surgical treatment is based on the degree and location of renal trauma. Grade IV injuries are a heterogeneous group and management should be tailored to the patient, especially among pediatric patients. Persistent urinary extravasation and/or symptomatic urinoma is a common complication of high-grade renal trauma, which will be amenable to ureteral stent placement or percutaneous drainage. For huge urinoma, synchronous percutaneous nephrostomy drainage and retrograde ureteral catheterization can relieve symptoms quickly.

Keywords: Renal Trauma, Grade IV laceration, Pediatric, Urinoma, Percutaneous drainage

DOI: 10.3233/XST-190611

Journal: Journal of X-Ray Science and Technology, vol. 28, no. 2, pp. 357-367, 2020