覆膜支架置入成功治療孕婦五級腎創傷

黃國倫¹、吳俊賢^1、2、林嘉祥^1、2、陳思翰^1、2

¹義大醫療財團法人義大醫院 泌尿科；

²義守大學 醫學系

Successful Management of Grade V Renal Trauma with Covered Stent Placement in a Pregnant Woman
Allen, Guo-Lun Huang¹, Chun-Hsien Wu^1,2, Victor C. Lin^1,2, Sih-Han Chen^1,2

Department of Urology¹, E-Da Hospital, Kaohsiung, Taiwan;

School of Medicine, College of Medicine², I-Shou University, Kaohsiung, Taiwan

Introduction: Grade V renal injuries, as classified by the American Association for the Surgery of Trauma (AAST), often present with hemodynamic instability and are frequently accompanied by major associated injuries, leading to a high rate of surgical exploration and nephrectomy. Transarterial embolization of the renal artery is currently a widely recommended non-operative approach for managing grade V renal injuries. However, covered stent placement offers a promising alternative for stabilizing patients and preserving renal function, particularly in cases where nephrectomy might otherwise be necessary. This case report highlights the role of covered stent placement in managing severe renal trauma.

Case report: A 33-year-old pregnant woman at 25 weeks of gestation sustained major trauma following a motor vehicle accident and was brought to our emergency department with clear consciousness. On examination, her vital signs indicated hypotension and tachycardia, suggestive of hypovolemic shock. Focused Assessment with Sonography for Trauma (FAST) revealed fluid accumulation in the splenorenal fossa, raising suspicion of internal bleeding. Bedside ultrasound detected no fetal heartbeat, leading to a diagnosis of intrauterine fetal death. Whole-body contrast-enhanced computed tomography (CT) showed a grade III laceration in the right posterior liver segment and a grade V left renal artery laceration with contrast extravasation, as per the AAST grading system (Fig. 1A). Given the severity of her injuries and hemodynamic instability, transarterial embolization of renal artery was recommended to control the hemorrhage. Angiography of the left renal artery confirmed active contrast extravasation and a pseudoaneurysm originating from the main trunk of the left renal artery. A covered stent (Viabahn® 7 mm x 5 cm) was successfully placed to seal the bleeding site. A follow-up angiogram after stent placement showed cessation of contrast extravasation, though only 50% of the kidney retained blood perfusion (Fig. 1B). The patient’s hemodynamics stabilized post-procedure. Two weeks later, a renal ultrasound revealed doppler flow over the middle and lower pole of kidney, indicating restored partial renal perfusion. Laboratory data showed renal function within normal limit.

Conclusion: This case underscores the use of covered stent placement effectively controlled severe renal artery bleeding, restoring hemodynamic stability and preserving renal function.