After A, a young male presented with non-pulsatile retroperitoneal hematoma. On table IVU was done. Right kidney was not visualized. Left kidney showed immediate excretion of dye. What is next step in the management?
The correct option should be "take the control or explore proximal renal vessels before opening Gerot&;s fascia", to avoid excessive intra-operative bleeding. Excretory Urography (IVU or IVP) - Campbell 11th edition P1151 Historically, excretory urography was the most commonly used modality to evaluate genitourinary injuries. Largely replaced by CT, a limited role includes the intra-operative "sigle-shot" IVP. The indications are uncommon, but when the surgeon encounters an unexpected retroperitoneal hematoma surrounding a kidney during abdominal exploration, the study can provide essential information. The main purpose of the one-shot IVP is to assess the presence of a functioning contralateral kidney and to radiologically stage the injured side. If findings are not normal or near normal , the kidney should be explored to complete the staging of the injury and reconstruct any abnormality found In the given problem, patient is having a non-pulsatile hematoma, which is not an indication for surgical exploration. On table IVU was done to see the functionn of contralateral kidney, the function of opposite kidney should be aseained before planning nephrectomy in any trauma patient. Angiography is largely used to define aerial injuries suspected on CT or to localize and control aerial bleeding. Renal embolization has proved useful in the primary setting with persistent bleeding in a hemodynamically stable patient. Take the control or explore proximal renal vessels before opening Gerota&;s fascia", to avoid excessive intra-operative bleeding. Ref: Smith 18th edition Pgno: 286
Nephrectomy
Open Gerotas fascia and explore proximal renal vessels
Perform retrograde pyelography
Perform on table angiography
Urology