Imaging modalities and management of pediatric high-grade renal trauma in an Indonesian tertiary hospital: a report of two cases and literature review

Abstract

As one of the most commonly injured organs in the genitourinary system during trauma, a thorough understanding of pediatric renal trauma's diagnosis and management is essential for physicians. The improvement of imaging modalities in recent years has shifted most treatments to a conservative approach. Non-operative management could reduce the risk of nephrectomy while increasing renal salvage rate. However, high-grade pediatric renal injury management remains controversial. We aimed to report two children with high-grade renal trauma, diagnosed using computed tomography and retrograde pyelography studies, undergoing different approaches. The first patient underwent a nephrectomy, whereas the second patient underwent non-operative management.

Keywords: Imaging modality; Nephrectomy; Non-operative management; Pediatric renal injury; Pediatric renal trauma.

Fig. 1

(A, B) Axial view of the contrast-enhanced abdominal CT indicating a grade 5 right renal trauma with active perirenal hemorrhage.

Fig. 2

Sagittal view of the contrast-enhanced abdominal CT indicating a mid-posterior rupture and urinoma.

Fig. 3

Resected renal tissue post-subcapsular nephrectomy.

Fig. 4

Sagittal view of the contrast-enhanced abdominal CT indicating a grade 5 renal trauma and urinoma.

Fig. 5

(A, B) Right RPG showing contrast filling the kidney and extravasation. RPG, retrograde pyelography.