The role of interventional radiology for pediatric blunt renal trauma

Italian Journal of Pediatrics

Chien-Heng Lin¹  Wei-Ching Lin² 

[1] Division of Pediatric Pulmonology, Children’s Hospital of China Medical University, No. 2, Yuh-Der Road, Taichung, Taiwan, R.O.C;Depatment of Biomedical Imaging and Radiological Science, College of Health Care, China Medical University, Taichung, Taiwan

关键词: Extravasation;    Children;    Renal trauma;    Interventional radiology;   

Others  :  1232082
DOI  :  10.1186/s13052-015-0181-z

 received in 2015-07-19, accepted in 2015-09-30,  发布年份 2015

【 摘 要 】

Background

This study aimed to appraise the role of interventional radiology in children with blunt renal trauma.

Methods

The clinical data, injury severity score, days of hospital stay, outcomes and complications of pediatric renal trauma were recorded and evaluated. The two groups: the transcatheter arterial embolization (TAE) group and the non-TAE group were compared for clinical features and laboratory data.

Results

Eighteen pediatric patients (12 boys, 6 girls with average age 12.4 ± 4.7 years) with blunt renal injury were included in the study. Six patients underwent angiography because of contrast medium extravasations in the kidney found on computed tomography of which four subsequently underwent a TAE. The clinical features and laboratory data of patients in the TAE and non-TAE groups were not significantly different. All patients were managed successfully by conservative treatment without complications except one in the non-TAE group who required nephrectomy due to renal arterial hypertension directly related to trauma. Both groups had relatively good results and all patients had normal renal function at follow-up.

Conclusion

TAE is an alternative therapeutic modality for blunt renal injury in children who have contrast medium extravasations in the kidney on angiography.

【 授权许可】

   
2015 Lin and Lin.

【 图 表 】

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【 参考文献 】

• [1]Blair M: Overview of genitourinary trauma. Urol Nurs 2001, 31(3):139-145.
• [2]Lee YJ, Rha SE, Byun JY: Renal trauma. Radiol Clin North Am 2007, 45(3):581-592.
• [3]Rzucidlo SE, Shirk BJ: Trauma nursing: pediatric patients. RN 2004, 67(6):36-42.
• [4]Wessel LM, Scholz S, Jester I, Arnold R, Lorenz C, Hosie S, et al.: Management of kidney injuries in children with blunt abdominal trauma. J Pediatr Surg 2000, 35(9):1326-1330.
• [5]Moore EE, Shackford SR, Pachter HL, McAninch JW, Browner BD, Champion HR, et al.: Organ injury scaling: spleen, liver, and kidney. J Trauma 1989, 29:1664-1666.
• [6]Fraser JD, Aguayo P, Ostlie DJ, St Peter SD: Review of the evidence on the management of blunt renal trauma in pediatric patients. Pediatr Surg Int 2009, 25:125-132.
• [7]Margenthaler JA, Weber TR, Keller MS: Blunt renal trauma in children: experience with conservative management at a pediatric trauma center. J Trauma 2002, 52:928-932.
• [8]Buckley JC, McAninch JW: Pediatric renal injuries: management guidelines from a 25-year experience. J Urol 2004, 172:687-690.
• [9]Salem HK, Morsi HA, Zakaria A: Management of high-grade renal injuries in children after blunt abdominal trauma: experience of 40 cases. J Pediatr Urol 2007, 3:223-229.
• [10]van der Vlies CH, Olthof DC, van Delden OM, Ponsen KJ, de la Rosettle JJ, de Reijke TM, et al.: Management of blunt renal injury in a level I trauma centre in view of the European guidelines. Injury 2012, 43:1816-20.
• [11]Lin WC, Lin CH, Chen JH, Chen YF, Chang CH, Wu SC, et al.: Computed tomographic imaging in determining the need of embolization for high-grade blunt renal injury. J Trauma Acute Care Surg 2013, 74:230-235.
• [12]Eassa W, EI-Ghar MA, Jednak R, EI-Sherbiny M: Nonoperative management of grade 5 renal injury in children: does it have a place? Eur Urol 2010, 57:154-163.
• [13]Kiankhooy A, Sartorelli KH, Vane DW, Bhave AD: Angiographic embolization is safe and effective therapy for blunt abdominal solid organ injury in children. J Trauma 2010, 68:526-531.
• [14]Quinlan DM, Gearhart JP: Blunt renal trauma in childhood. Features indicating severe injury. Br J Urol 1990, 66:526-531.
• [15]Stein JP, Kaji DM, Eastham J, Freeman JA, Esrig D, Hardy BE: Blunt renal trauma in the pediatric population: indications for radiographic evaluation. Urology 1994, 44:406-410.
• [16]Sivit CJ: Imaging children with abdominal trauma. AJR Am J Roentgenol 2009, 192:1179-1189.
• [17]Balkan E, Kilic N, Dogruyol H: Indirect computed tomography sign of renal artery injury: retrograde filling of the renal vein. Int J Urol 2005, 12:311-2.
• [18]Rogers CG, Knight V, MacUra KJ, Ziegfeld S, Paidas CN, Mathews RI: High-grade renal injuries in children: Is conservative management possible? Urology 2004, 64:574-579.
• [19]Altman AL, Haas C, Dinchman KH, Spirnak JP: Selective nonoperative management of blunt grade 5 renal injury. J Urol 2000, 164:27-30.
• [20]Henderson CG, Sedberry-Ross S, Bulas DI, Bulas DI, Duffy BJ, Tsung D, et al.: Management of high grade renal trauma: 20-year experience at a pediatric level I trauma center. J Urol 2007, 178:246-250.
• [21]Breyer BN, McAninch JW, Elliott SP, Master VA: Minimally invasive endovascular techniques to treat acute renal hemorrhage. J Urol 2008, 179:2248-2252.
• [22]Puapong D, Brown CV, Katz M, Kasotakis G, Applebaum H, Salim A, et al.: Angiography and the pediatric trauma patient: a 10-year review. J Pediatr Surg 2006, 41:1859-1863.
• [23]Dinkel HP, Danuser H, Triller J: Blunt renal trauma: minimally invasive management with microcatheter embolization experience in nine patients. Radiology 2002, 223:723-730.
• [24]Vo NJ, Althoen M, Hippe DS, Prabhu SJ, Valji K, Padia SA: Pediatric abdominal and pelvic trauma: safety and efficacy of arterial embolization. J Vasc Interv Radiol 2014, 25:215-220.
• [25]Russell RS, Gomelsky A, McMahon DR, Andrews D, Nasrallah PF: Management of grade IV renal injury in children. J Urol 2001, 166:1049-1050.
• [26]Nance ML, Lutz N, Carr MC, Canning DA, Stafford PW: Blunt renal injuries in children can be managed nonoperatively: outcome in a consecutive series of patients. J Trauma 2004, 57:474-478.
• [27]Montgomery RC, Richardson JD, Harty JI: Posttraumatic renovascular hypertension after occult renal injury. J Trauma 1998, 45:106-110.
• [28]Burney B, Oliva R, Zorn KC, Bakris G: Hyperension following kidney injury. J Clin Hypertens (Greenwich) 2010, 12:727-730.