Renal trauma during laparotomy for intra-abdominal injury.

The advantages of nonsurgical or surgical management of renal injuries are important when the renal trauma is found during a laparotomy for intra-abdominal injury. Blunt external trauma caused 85.5 percent of the renal injuries found during laparotomy in 194 patients. A large dose or infusion intravenous pyelogram on a modified operating table has allowed immediate evaluation of the renal injury during a laparotomy. When the degree of renal injury was more severe, renal tissue and function were saved by early surgical management. In this group, lowered morbidity and a sharp reduction in delayed renal operations followed the introduction of immediate surgical management. The nephrectomy rate was 11 percent, which compares favorably with that of nonsurgical management. Clamping of the renal vessels prior to opening Gerota fascia prevented reactivation of hemorrhage and allowed for a deliberate operation with conservation of undamaged renal tissue.