Usefulness of CT scan in managing blunt renal trauma

ABSTRACT

Objective to evaluate the usefulness of CT scan in selecting patients for appropriate management of patients presenting with blunt abdominal trauma and haematuria. 23 consecutive patients were referred from the surgical emergency with blunt abdominal trauma and haematuria for CT scan abdomen. CT scan findings were analysed and graded according to the extent of renal as well as vascular injury. These patients were then followed up during their hospital stay and the choice of treatment i.e surgical versus conservative and it outcome was recorded prospectively. 18 patients [78%] had renal trauma. The renal trauma in these 18 patients was classified according to CT findings in to five grades according to classification of the Organ Injury Scaling Committee of the American Association for the Surgery of Trauma. Five patients [27.8%] were in grade 1, three patients [16.6%] in grade 2, three patients [16.6%] in grade 4, four patients [22.4%] in grade 4 and three patients [16.6%] in grade 5.All patients in grades 1, 2 and 3 were treated conservatively whereas all patients in grade 5 had to undergo laparotomy and only one patient in Grade 4 required laprotomy due to rapidly expanding urinoma and deteriorating clinical condition. Five patients had non renal trauma and two of these had a ureteric injury .These patients did not require any exploration. CT scan is an effective method to stage and grade the severity of renal injury and is of extreme help to the surgeons in selecting patients for exploratory surgery