Blunt injury abdomen(renal trauma&mesenteric trauma)

1. BLUNT INJURY ABDOMEN
INJURIES TO KIDNEY
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- Dr. Vinay kumar Pokala

2. RENAL TRAUMA
• 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. vinay

3. RENAL TRAUMA
TYPES
A. Small subcapsular
B. Large subcapsular
C. Cortical laceration
D. Laceration with perinephric
haematoma
E. Medullary laceration
F. Corticomedullary complete
rupture
G. Hilar injury (most dangerous)

4. RENAL TRAUMA
• Grading of renal injury
1) 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.
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5. RENAL TRAUMA
• 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.
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6. 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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7. RENAL TRAUMA
• TREATMENT
I. 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.
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8. RENAL TRAUMA
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.
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9. RENAL TRAUMA
• 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.
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10. 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.
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11. BLUNT INJURY ABDOMEN
MESENTERIC TRAUMA
- Dr. Vinay kumar

12. 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.

13. MESENTERIC TRAUMA
HAEMOPERITONEUM

14. 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.

15. MESENTERIC TRAUMA
• INVESTIGATIONS
• Ultra sound abdomen.
• Diagnostic peritoneal lavage.
• CT abdomen.
• Haematocrit,electrolyte estimation,blood
grouping.

16. MESENTERIC TRAUMA
CECT scan showing mesenteric haematoma

17. MESENTERIC TRAUMA
• TREATMENT
• Emergency laparotomy and
resection of bowel or suturing of
the mesentry.
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18. vinay