Major Renal Lacerations with a Devitalized Fragment following Blunt Abdominal Trauma: A Comparison between Nonoperative (Expectant) Versus Surgical Management

Of 43 patients who sustained blunt trauma resulting in a major renal laceration with a devitalized fragment 27 had coexisting intraperitoneal and renal injuries for which emergency celiotomy and repair of the nonurological trauma were done. Management of the renal injuries consisted of simultaneous renal exploration with 23% urological morbidity in 13 cases or expectant management with 85% urological morbidity in 14 cases. In this latter patient population infected urinomas and perinephric abscesses seeded from coexisting enteric or pancreatic injuries were the most common complication (57%). The remaining 16 of the 43 patients sustained renal lacerations without associated intraperitoneal injuries and all were managed expectantly with 38% urological morbidity. These findings suggest that renal exploration and surgical repair significantly improve the prognosis only in patients with simultaneous intraperitoneal and renal injuries (p < 0.01).