腹部鈍傷引起之腎節梗塞
胡蔚祥,謝肇新,許兆畬,童敏哲,歐宴泉
童綜合醫院 外科部 泌尿科
Segmental renal infarction resulting from blunt abdominal trauma
Wei-Shiang Hu, Siu-San Tse, Chao-Yu Shu, Min-Che Tung, Yen-Chuan Ou
Division of Urology, Department of Surgery,
Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan
Introduction
Blunt abdominal trauma is commonly seen at the emergency department. However, segmental renal infarction secondary to the blunt abdominal trauma is a rare situation. We represent a case of segmental renal infarction sustaining multiple traumas following a traffic accident.
Case report
A 15-year-old man without previous medical history presented to the emergency department following a motor vehicle accident. On arrival, the patient did not represent cardio-pulmonary distress in appearance. His blood pressure was recorded as 110/55 mmHg. Initial assessment revealed a GCS of E4M6V5, left-sided chest and loin bruising, deformity of left arm and bilateral wrists. Apart from bruises, abrasions, and deformities due to the trauma, no other manifestation was observed.
Electrocardiogram showed normal sinus rhythm. Pneumothorax and other chest pathology were excluded by chest X ray. Laboratory investigations presented an elevated white blood cell count of 17.5 x103/ μL, hemoglobin of 15.3 g/dL, high alanin aminotransaminase of 81 IU/L, normal serum creatinine of 0.84 mg/dL. Contrast-enhanced computed tomography demonstrated contusive hemorrhage of bilateral lung. Besides, a demarcated, wedge-shaped, non-enhanced anterior, middle segment of renal parenchyma was presented, indicating a left segmental renal infarction. No extravasation nor perinephritic hematoma was detected.
Following the investigations, the patient was shifted to intensive care unit. We treated him conservatively. Thrombolytic agent was avoided for fear that contusive hemorrhage might aggravate. Apart from mild asymptomatic hypertension, he represented well the following days. He was finally discharged from hospital in a stable condition. We report our experience of managing this patient and review of the literature.