Blunt renal trauma in children: the experience of Mohammed VI University Hospital of Oujda in Morocco between 2015 and 2021

Abstract

Introduction: blunt renal traumas in children are rare and their management is not suited to a very clear consensus. We sought to report our experience in managing renal injuries in children presented after blunt abdominal trauma.

Methods: data of children aged less than 16 years with blunt renal injuries between January 2015 and April 2021 were retrospectively reviewed. Demographic characteristics, clinical course, biological results, radiological findings, associated injuries, management and follow up of included patients were described. Renal lesions were classified according to the American Association for the Surgery of Trauma (AAST).

Results: we included a total of 20 children, of whom 70% (n=14) were males. The mean of age was 8.50 ± 3.42 years. Falls in 65% (n=13) and motor-vehicle accidents in 35% (n=7) were the two main mechanisms of injuries. Abdominal pain was the most common symptom and macroscopic hematuria was assessed in 55% of patients (n=11). Low-grade injuries (I-III) represented 40% of the cases (n=8), 60% of injuries were AAST grade IV (n=12) and none with AAST grade V was diagnosed. Spleen injuries in 25% (n=5) as well as traumatic brain injuries in 25% (n=5) were the most identified concomitant injuries followed by liver lesions in 15% (n=3). 75% of renal injuries (n=15) were managed conservatively and all cases that required an operative management were with AAST grade IV. No nephrectomy in our series was performed and the follow up was favorable with a median of 3 years.

Conclusion: our data suggest that the majority of children with blunt renal injuries can be managed conservatively regardless the grade of lesions as long as no hemodynamic instability or symptomatic urinoma are identified.

Keywords: American Association for the Surgery of Trauma (AAST); Blunt renal trauma; Kidney Injury Scale; children; conservative management.

Figure 1

A) axial and B) sagittal abdominal contrast enhanced CT performed after a blunt abdominal trauma in an 11-years-old boy showing a parenchymal laceration of the right kidney (grade III of AAST Kidney Injury Scale) (blue arrows) associated with a voluminous hematoma of the liver (white arrow) after falling from standing height and who was managed conservatively

Figure 2

A) axial and B) coronal abdominal contrast enhanced CT performed after a blunt abdominal trauma in a 2-years-old boy showing an extended parenchymal laceration of the left kidney (grade IV of AAST Kidney Injury Scale) (blue arrows) associated with perirenal hematoma (white arrow) after falling from high and who was managed conservatively