腎結石掉出併腎臟撕裂傷:案例報告

陳浩恩^1,3、陳進利^2,3、曹智惟^2,3、蒙恩^2,3、吳勝堂^2,3、查岱龍^2,3、于大雄^2,3、孫光煥^2,3

¹國軍臺中總醫院外科部泌尿外科, ²三軍總醫院外科部泌尿外科, ³國防醫學大學

 Traumatic Renal Laceration Complicating Renal Stone Dropped Out of the Kidney–A case report

 Hao-En Chen^1,3, Chin-Lin Chen^2,3, Chih-Wei Tsao^2,3, En Meng^2,3, Sheng-Tang Wu^2,3, Tai-Lung Cha^2,3, Dah-Shyong Yu^2,3, Guang-Huan Sun^2,3

¹ Division of Urology, Department of Surgery, Taichung Armed Forces General Hospital, Taichung, Taiwan

² Division of Urology, Department of Surgery, Tri-Service General Hospital, Taipei, Taiwan

³ National Defense Medical University, Taipei, Taiwan

Introduction:

Abdominaltraumawhichcausedbybluntinjuryistheleadingcauseofmorbidityandmortalityinallagepatients. Approximately 10% of traumatic patients coming to emergency department have a blunt injury. However, in our case, renal laceration as a complication of renal stone dropped out of the kidney after falling down has never been reported.

Case presentation:

We present the case of a 74-year-old man who had abdominal dull pain on left flank region and gross hematuria for one day after falling down. The KUB showed radiopaque calcification on left abdominal region. The abdomen computed tomography showed left renal laceration extending into the collecting system with surrounding perinephric stranding. Additionally, we found radiopaque stones in left renal pelvis and perinephric space without beyond Gerota’s fascia.

It was compatible with grade IV traumatic renal laceration complicating renal stone dropped out of the kidney. He underwent a retroperitoneal exploration and found a brownish stone, measured approximately 3.0 x 2.5 cm, outside the laceration of lower pole of left kidney. The laceration measured about 3.0 x 3.0 cm. After removal of the renal stones, we repaired the laceration. The patient recovered uneventfully and was discharged on post-operative day 6.

Conclusion:

Traumatic laceration of kidney is potentially life threatening. The major causes of renal laceration include motor vehicle accident, contact sports, fights, and less often penetrating injury. Direct blow is the leading mechanism which accounts for more than 80% of patients and frequently compresses the kidney. To our knowledge, this is a rare documented case of renal laceration as a complication of renal stone dropped out of the kidney resulted from a fall. Renal laceration resulted from renal stone dropped out of the kidney is rarely reported. Hematuria is the commonest symptom of renal laceration; however, this unspecific symptom can result from lots of diseases. Management of this unusual patient requires a cautious approach and surgical intervention might be inevitable.