During renal rupture the nephrectomy is NOT attempted until
(Contra-lateral renal function is scertain)Nephrectomy is a possibility so it is important to establish that the contralateral kidney is functioning (1291- Bally & Love 25th)Injury to the Kideny * Haematuria is a cardinal sign of a damaged kidney *** Meterorism - abdominal distension comes on about 24-48 hours after the accident (retroperitoneal haematoma implicating splanchnic nerves)* An Intravenous urogram (IVP) should be obtained urgently to show that the other kidney is normal. A leak of urine on the damaged side is often demonstrated* Before proceeding to surgical procedure for bleeding a renal arteriogram should be performed if possible. If the bleeding vessel is visualized it may be embolised with small starch microspheres to stop bleeding* Should the necessity for a urgent operation arise and facilities for urography not be available, the presence of a functioning kidney on the contralateral side can often be confirmed by chromo- cystoscopyTREATMENT1. Nephrectomy - Kidney is found to rupture in several places or kidney pedicle is damaged2. Small tear can be sutured over oxycel or a piece of detached muscle3. Nephrostomy - Larger single rents in the middle of the kidney4. Partial Nephrectomy - laceration is confined to one pole of the kidney
Fluid replacement
Antibiotics covers
Contralateral renal function is ascertain
Renal angiogram
Kidney & Ureturs