A 15-year-old male with no relevant medical and surgical history was admitted to the emergency department after a moderate-intensity fortuitous blow to the right flank while practicing handball.
She complained of continuous pain in the non-irradiated right hemiabdomen, vomiting, and onset of macroscopic hematuria in the subsequent hour.
The physical examination revealed fever, moderate cutaneous-mucosal dryness, tenderness and conscientious preservation of the mass in the right hypochondrium and empty abdominal sounds.
Neurological evaluation was normal.
Blood pressure: 80/40 mmHg.
Heart rate: 80 beats/min.
Initial blood analysis showed Hb:12.2 g/dl, Ht: 3%, 22,200 leukocytes/mm3, neutrophils 82% and creatinine: 0.6 mg/dl, the coagulation study was normal.
Urine analysis showed macroscopic hematuria, proteins >300 mg/dl, glucose 250 mg/dl, positive nitrites and a high bilirubin level.
A simple abdominal X-ray showed a blurring of the right renopsoas line.
Abdominal ultrasound reported right renal rupture with retroperitoneal hematoma up to the right iliac fossa, contusion of the posterior segment of the right hepatic lobe with minimal amount of free periheptic fluid and normal bladder cavity with multiple clots. b
With the patient monitored for a large line of left kidney and remained stable after fluid and electrolyte replacement, a CAT scan was performed with a retropelvic fistula with contrast, identifying possible horseshoe kidneys with a fracture of the upper pole arteriovenous.
1.
This new data preservation, the serial clinical and analytical stability and the cesion of hematuria with diuresis, the patient is constantly monitored in the ICU, allowing an adequate planning for conservative surgery.
Four concentrates were gradually transfused, with a hematocrit of 28% remaining unchanged.
Despite the favorable evolution of the retroperitoneal hematoma, due to the intermittent reappearance of small hematuria and the possibility of a vascular fistula, the intervention is programmed 16 days after admission.
A right lumbotomy was performed with evacuation of the organized perirenal hematoma and extraction of three fragments of renal parenchyma corresponding to the upper pole and the right external mesorenal area devitalized.
A right ureteral catheter was placed by pyelotomy and a percutaneous catheter Malecot 14 Ch., with suture of the inferior callus and mesorenal area.
Twelve days later, the patient developed fever and urine output through the drainage, so a right ureteral double J catheter was placed, resulting in ineffective.
Maintaining the drainage, the bladder catheter and an outpatient ultrasound control for absence of obstruction resolved conservatively postsurgical urinary fistula.
Three years later, the patient had normal renal function.
1.
The anatomopathological report of the right partial nephrectomy for traumatic rupture of horseshoe kidney revealed absence of glomerulus-tubular pathology, with extensive hemorrhage and interstitial necrosis and presence of fragmented right adrenal gland.
