Renal trauma in multiple-injured child

Between 1959 and 1981, 251 renal injuries occurred in 248 children up to the age of sixteen years. Of the 36 children with renal laceration, rupture, or pedicle injury, 35 (97%) had associated injuries; 31 of these children (89%) with associated injuries required an immediate laparotomy by general surgeons for intra-abdominal injury. Immediate surgical management was performed on 27 severe renal injuries and resulted in nephrectomy in 3 of 20 renal lacerations (15%), in 4 of 4 ruptures (100%), and in 1 of 3 pedicle injuries (33%). Two of the 3 pedicle injuries (67%) had immediate repair with salvage of the kidney. Conservative management was carried out in 10 severe renal injuries. Delayed renal surgery was required in 3 cases (30%) and total renal loss (nephrectomy plus main renal artery injury) occurred in 5 of the 10 cases (50%). The severe degrees of renal injury did not all settle by themselves. Immediate surgical management of the patient with a severe renal injury resulted in a nephrectomy rate comparable with that of conservatively managed renal injuries.