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      Case report of bilateral penetrating renal trauma caused by a wooden stick

      case-report
      , PhD, , PhD, , MD, , PhD
      Medicine
      Wolters Kluwer Health
      bilateral penetrating renal trauma, nephrectomy, renal salvage, renorrhaphy

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          Abstract

          Rationale:

          Kidney is the most frequently injured organ of the genitourinary system during trauma. Bilateral penetrating renal trauma (BPRT) is extremely rare and sporadically reported in the previous literature. Here, we reported a unique case of BPRT.

          Patient concerns:

          A 43-year-old man, with no medical history, was accidentally penetrated by a wooden stick and presented with sharp pain in the left flank.

          Diagnosis:

          Laboratory tests revealed microscopic hematuria, mildly elevated leucocyte and amylase, normal hemoglobin (145 g/L) and creatinine (1.05 mg/dl). Computed tomography demonstrated bilateral penetrating renal injuries with perinephric/subcapsular hematoma, fracture of the second lumbar vertebra and 10th rib.

          Interventions:

          An emergency exploratory laparotomy was executed immediately. According to the American Association for the Surgery of Trauma Organ Injury Scale grading system, grade V and III injuries were considered for the left and right kidney, respectively. Nephrectomy and renorrhaphy were performed on the left and right kidney, respectively.

          Outcomes:

          The postoperative course was uneventful. Eleven days after the surgery, the patient discharged with no complications.

          Lessons:

          We present a rare and challenging case which was handled successfully, and it may provide useful information for the management of BPRT.

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          Most cited references16

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          Organ injury scaling: spleen, liver, and kidney.

          The Organ Injury Scaling (O.I.S.) Committee of the American Association for the Surgery of Trauma (A.A.S.T.) was appointed by President Trunkey at the 1987 Annual Meeting. The principal charge was to devise injury severity scores for individual organs to facilitate clinical research. The resultant classification scheme is fundamentally an anatomic description, scaled from 1 to 5, representing the least to the most severe injury. A number of similar scales have been developed in the past, but none has been uniformly adopted. In fact, this concept was introduced at the A.A.S.T. in 1979 as the Abdominal Trauma Index (A.T.I.) and has proved useful in several areas of clinical research. The enclosed O.I.S.'s for spleen, liver, and kidney represent an amalgamation of previous scales applied for these organs, and a consensus of the O.I.S. Committee as well as the A.A.S.T. Board of Managers. The O.I.S. differs from the Abbreviated Injury Score (A.I.S.), which is also based on an anatomic scale but designed to reflect the impact of a specific organ injury on ultimate patient outcome. The individual A.I.S.'s are, of course, the basic elements used to calculate the Injury Severity Score (I.S.S.) as well as T.R.I.S.S. methodology. To ensure that the O.I.S. interdiffuses with the A.I.S. and I.C.D.-9 codes, these are listed alongside the respective O.I.S. Both the currently used A.I.S. 85 and proposed A.I.S. 90 are provided because of the obligatory transition period. Indeed, A.I.S. 90 contains the identical descriptive text as the current O.I.S.'s. The Abdominal Trauma Index and other similar indices using organ injury scoring can be easily modified by replacing older scores with the O.I.S.'s.(ABSTRACT TRUNCATED AT 250 WORDS)
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            Renal trauma: the current best practice.

            The kidneys are the most vulnerable genitourinary organ in trauma, as they are involved in up to 3.25% of trauma patients. The most common mechanism for renal injury is blunt trauma (predominantly by motor vehicle accidents and falls), while penetrating trauma (mainly caused by firearms and stab wound) comprise the rest. High-velocity weapons impose specifically problematic damage because of the high energy and collateral effect. The mainstay of renal trauma diagnosis is based on contrast-enhanced computed tomography (CT), which is indicated in all stable patients with gross hematuria and in patients presenting with microscopic hematuria and hypotension. Additionally, CT should be performed when the mechanism of injury or physical examination findings are suggestive of renal injury (e.g. rapid deceleration, rib fractures, flank ecchymosis, and every penetrating injury of the abdomen, flank or lower chest). Renal trauma management has evolved during the last decades, with a distinct evolution toward a nonoperative approach. The lion's share of renal trauma patients are managed nonoperatively with careful monitoring, reimaging when there is any deterioration, and the use of minimally invasive procedures. These procedures include angioembolization in cases of active bleeding and endourological stenting in cases of urine extravasation.
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              Analysis of diagnostic angiography and angioembolization in the acute management of renal trauma using a national data set.

              To our knowledge data on diagnostic angiography and angioembolization after renal trauma have been limited to single institution series with small numbers. We used the National Trauma Data Bank® to investigate national patterns of diagnostic angiography and angioembolization after blunt and penetrating renal trauma.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                April 2020
                17 April 2020
                : 99
                : 16
                : e19853
                Affiliations
                Department of Urology, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, Shenzhen, China.
                Author notes
                []Correspondence: Ke-feng Xiao, Department of Urology, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, Shenzhen 518020, China (e-mail: kevin5510315@ 123456163.com ).
                Article
                MD-D-19-06319 19853
                10.1097/MD.0000000000019853
                7220106
                32312008
                977b875e-d5f0-4120-b227-e34969222565
                Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

                History
                : 11 August 2019
                : 23 January 2020
                : 12 March 2020
                Categories
                7300
                Research Article
                Clinical Case Report
                Custom metadata
                TRUE

                bilateral penetrating renal trauma,nephrectomy,renal salvage,renorrhaphy

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