blunt injury abdomen(renal trauma&mesenteric trauma)
DESCRIPTION
Blunt injury abdomen(renal trauma&mesenteric trauma)TRANSCRIPT
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BLUNT INJURY ABDOMENINJURIES TO KIDNEY
- Dr. Vinay kumar Pokala
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• Commonly it is due to a blunt injury.• Often it is associated with other abdominal injuries- of
liver,spleen,bowel,mesentry,etc.
• Clinical features• Features of shock• Haematuria-may be mild to profuse depending on
the type of injury.• Sudden delayed profuse haemorrhage causing
haematuria can occur between 3rd day to 3rd week after trauma.
• Clot colic;bruising,swelling and tenderness in the loin.
RENAL TRAUMA
RENAL TRAUMA
TYPESA. Small subcapsularB. Large subcapsularC. Cortical lacerationD. Laceration with perinephric
haematomaE. Medullary lacerationF. Corticomedullary complete
ruptureG. Hilar injury (most dangerous)
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• Grading of renal injury1) Subcapsular non expanding haematoma.2) Cortical laceration < 1cm of parenchymal
depth.3) Cortical laceration > 1cm of depth.4) Parenchymal laceration extending through
cortex and medulla with collecting system.5) Renal pedicle avulsion;shattered kidney.
RENAL TRAUMA
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• INVESTIGATIONS• IVU (high dose)• U/S abdomen• Blood urea and serum creatinine should be
repeated at regular intervals.• Blood grouping and cross-matching for blood
transfusion.• Emergency CT scan.
RENAL TRAUMA
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RENAL TRAUMA
Kidney trauma. Grade 1 renal injury, contusion. Image from a contrast-enhanced CT scan of the abdomen in a patient with hematuria after a motor vehicle collision shows ill-defined area of hypoenhancement in the medial right kidney.
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• TREATMENTI. Initially always conservative: -
catheterise & watch the urine colour and output. -blood transfusion -regular monitoring of the pulse,BP,temperature,U/S follow-up daily. -sedation,analgesic,antibiotics. -75% of patients respond to conservative management.
RENAL TRAUMA
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ii). Indications for surgical intervention -when there are signs of progressive blood loss with the condition of the patient deteriorating. -formation of progressive perinephric haematoma.
-when there are associated other injuries. -hilar injury.
RENAL TRAUMA
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• SURGERY (Only 10-20% of Patients)• Gentle suturing of the laceration.often
kidney is friable,this is not possible.• When the injury in the poles partial
nephrectomy is done.• In hilar injury and severe laceration,
nephrectomy is the only choice.
RENAL TRAUMA
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RENAL TRAUMA
• COMPLICATIONS• Clot retention in the bladder and may go for
renal failure.• Pararenal pseudohydronephrosis.• Perinephric abscess.• Aneurysm of renal artery.• Hypertension occurs 3 months later.
BLUNT INJURY ABDOMENMESENTERIC TRAUMA
- Dr. Vinay kumar
MESENTERIC TRAUMA
• It is commonly seen in blunt abdominal trauma.• Traction injury or seat belt injury causes mesenteric
tear.
• PRESENTATIONS• Features of haemoperitoneum-
shock,pallor,abdominal distension and pain,guarding and rigidity.
MESENTERIC TRAUMA
HAEMOPERITONEUM
MESENTERIC TRAUMA
• Types• 1) transverse tear in mesentry causes not only
more bleeding but also causes adjacent bowel ischaemia.laparotomy & resection of bowel is needed.
• 2) longitudinal tear can be sutured using interrupted absorbable sutures after haemostasis.
MESENTERIC TRAUMA
• INVESTIGATIONS• Ultra sound abdomen.• Diagnostic peritoneal lavage.• CT abdomen.• Haematocrit,electrolyte estimation,blood
grouping.
MESENTERIC TRAUMA
CECT scan showing mesenteric haematoma
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MESENTERIC TRAUMA
• TREATMENT• Emergency laparotomy and
resection of bowel or suturing of the mesentry.
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THANK YOU …