Fig. 3.28 Renal trauma. There is a large right-sided perinephric haematoma surrounding the right kidney which is displacing it anteriorly.

Contrast enhanced CT is the gold standard for assessing renal trauma (Fig. 3.28). Delayed CT images are important when imaging for renal trauma to check for urine leak. Renal lacerations are irregular low-density areas in the parenchyma.

Lacerations through the hilum which contact two cortical surfaces are termed fractures. The majority of renal injuries can be managed without the need for surgery even in the presence of major laceration or urine leak. Grades 1 and 2 are managed non-operatively with excellent results; patients have normal functioning kidneys on follow-up imaging. Most patients with grade 3 and 4 injuries are managed non-operatively. Close monitoring of patients with grade 3 and 4 injuries with use of percutaneous drainage and angiographic embolisation (Fig. 3.29) has reduced the laparotomy rate in this group. Moderate urine leaks can be managed conservatively with ureteric stenting. Persistent large

Fig. 3.29 Renal angiogram. There is active bleeding/contrast extravasation from a segmental renal artery.

urine leak, pelvi-ureteric junction avulsion, enlarging central or subcapsular haematoma, extensive avascularised parenchyma and shock in the presence of intra-peritoneal or retro-peritoneal haematoma need surgical intervention. Attempted salvage of a devascularised kidney is contraversial but may not be attempted if the contralateral kidney is normal.

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