一個車禍引起嚴重的腎臟損傷案例報告

徐則中、薛又仁、黃建榮、賴昱維、李淑文、陳修聖、高國維、蕭毅君、邱文祥

臺北市立聯合醫院仁愛院區  外科部 泌尿科

A traffic accident induced severe renal trauma case report

Tze-Jung Shiu, Thomas Y. Hsueh, Andy C. Huang, Yu-Wei Lai, Shu-Wen Li, Shiou-Sheng Chen, Kuo-Wei Kao, Yi-Chun Hsiao, Allen W. Chiu

Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei, Taiwan

Introduction: We presented a traffic accident induced major trauma case with severe renal vascular injury and spleen injury.

Case presentation: This is a 73-year-old man with underlying disease of hypertension and Parkinsonism. He had traffic accident while riding motorcycle on 113/05/24 night. He fell down with left flank contusion with the floor, and he had cold sweating and severe left flank pain. Then he was sent to our hospital for help. At emergency department, his vital sign was stable, and his consciousness was clear. His blood test reported creatinine level 1.5 mg/dL. Abdomen CT showed left renal injury with subcapsular and perirenal hematoma, and active bleeding noted at CTA and suspect beyond Gerota fascia into retroperitoneum, with AAST grade 4 considered. Therefore, emergent surgery was arranged. During the surgery, left kidney laceration grade IV/V and spleen laceration were found. Hypotension was also noted in the operation. Therefore, left radical nephrectomy and splenectomy was performed. After observation at ICU for 3 days, he transferred to ordinary ward on 5/27, and he was discharged on 5/29.

The pathological diagnosis reported left kidney laceration with hemorrhage and blood clots coating, and spleen laceration. The specimen 1 showed laceration, with cortical damage and hemorrhage microscopically. Hemorrhage and blood clots are also seen in the hilar region and perirenal fat. The specimen 2 showed generally intact and smooth surface of spleen with a laceration wound measuring 1.3 x 1.2 cm in dimension, coated with blood clots. On serial section, subcapsular hemorrhage is seen. Microscopically, sections of the spleen show focal disruption of the capsule with hemorrhage. Vascular and sinusoid congestion is also seen.

    During the urological department follow-up, his general condition is stable, but creatinine level elevated to 2.31 mg/dL.

Discussion: We presented a severe renal trauma case which had emergent surgical rescue, which is uncommon in our hospital.