Complications

Early complications occur within the 1st month after injury and can be bleeding, arteriovenous fistulae involving the renal artery, infection, perinephric abscess, sepsis, urinary fistula, hypertension, urinary extravasation, and urinoma. Delayed complications include bleeding, hydronephrosis, calculus formation, chronic pyelonephritis, hypertension, arteriovenous fistula, hydronephrosis, and pseudoaneurysms.

Delayed retroperitoneal bleeding usually occurs within several weeks of an injury or procedure and may be life-threatening. Selective angiographic embolization is the preferred treatment (Heyns and van Vollen-hoven 1992a).

Perinephric abscess formation is usually best managed by percutaneous drainage, although open drainage may sometimes be required (McAninch et al. 1991). Percutaneous management of complications may poses less risk of renal loss than reoperation, which may lead to nephrectomy when infected tissues make reconstruction difficult.

Hypertension may occur acutely as a result of external compression from perirenal hematoma (Page kidney) or chronically because of compressive scar formation. Renin-mediated hypertension may occur as a long-term complication; etiologies include renal artery thrombosis, segmental arterial thrombosis, renal artery stenosis (Goldblatt kidney), devitalized fragments, and arteriovenous fistulae. Arteriography is informative in cases of post-traumatic hypertension (Montgomery et al. 1998). Treatment is required if hypertension persists and may include medical management, excision of the ischemic parenchymal segment, vascular reconstruction, or total nephrectomy. The frequency of post-traumatic hypertension is estimated to be less than 5 % in all published series (Lebech and Strange-Vognsen 1990; Monstrey et al. 1989).

Urinary extravasation after renal reconstruction often subsides without intervention as long as ureteral obstruction and infection are not present. Ureteral, retrograde stenting may improve drainage and allow healing (Haas et al. 1998b). Persistent urinary extravasation from an otherwise viable kidney after blunt trauma often responds to stent placement and/or percutaneous drainage as necessary (Matthews et al. 1997).

Arteriovenous fistulas usually present with delayed onset of significant hematuria, hypertension, heart failure, and progressive renal failure, most often after penetrating trauma. Percutaneous embolization or stenting of the renal artery is often effective for symptomatic arteriovenous fistulas, but larger ones may require surgery (Wang et al. 1998; Kavic et al. 2002). The development of pseudoaneurysm is a rare complication following blunt renal trauma. In numerous case reports, transcatheter embolization appears to be a reliable minimally invasive solution (Franco de Castro et al. 2001; Miller et al. 2002). Acute renal colic from a retained missile has been reported and may be managed endoscopically if possible (Harrington and Kandel 1997). Other unusual late complications, such as duodenal obstruction, may result from retroperitoneal hematoma following blunt renal trauma (Park et al. 2001).

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