張廷瑞、陳世亮、許智凱

台南市立醫院 泌尿科

Ting-Jui Chang, Shih-Liang Chen, Chih-Kai Hsu

Divisions of Urology, Tainan Municipal Hospital, Tainan, Taiwan

 

Background: Traumas associated with domestic animals attacks are commonly seen. In case of horse, most serious injuries occur when a rider is thrown from a horse. However, hoof kick injuries to an unmounted people represent about 30% of horse related injuries. Urinary system injury following abdominal trauma is observed at a level of approximately 10%; and the most common urological organ injured after trauma is the kidney. Here we present a case of young women suffered from renal trauma after horse attack.

Case Report: A 26 year old female patient presented to the ER department due to abdominal trauma. The patient described an attack by a horse to the right flank area. The patient had no rebound and no additional pathology other than ecchymosis in the lumbar region. CT scan confirm grade III renal trauma. The patient was placed under observation. Vital signs, intake and output and blood values were closely monitored. The patient had no additional problem and was discharged a week later. The follow up renal sonography showed the retroperitoneal localized hematoma had shrunk but still persisted; and not urinoma formation was noted.

Discussion: Thousands of injuries and hundreds of deaths due to trauma resulting from animal attacks occur every year. The species of animal causing trauma, and the type of trauma, varies according to geographical characteristics. Emet et al. evaluated trauma associated with 921 animals; most commonly is caused by dogs, 29.9%; follow by horse, 21.7%. Kidney trauma is seen in 8-10% of all blunt and penetrating abdominal injuries caused by animals. The basic imaging technique used is computerized tomography. Contrast CT is required for kidney trauma due to the need to image renal hemorrhage and the collecting system. Assessment and management of such patients is similar to that of general trauma patients. Conservative treatment based on close observation should be considered as the first treatment option for hemodynamically stable patients. Surgical procedure must be performed on patients who are not hemodynamically stable despite crystalloid and blood product replacement therapy and with expanding retroperitoneal hematoma and hemorrhage. Repeated tomography imaging may be useful in showing persisting or delayed hemorrhages.