43 / 330
43
19–22 APRIL, 2017, BARCELONA, SPAIN
16:15–16:17
S3-13 (CP)
OVERTREATMENT OR BEST CHANCE FOR KIDNEY
SALVAGE? MANAGEMENT OF TRAUMATIC RENAL ARTERY
OCCLUSION IN AN 11 YEAR-OLD-BOY
Mazen ZEINO
1
, Milan MILOSEVIC
2
, Cordula SCHERER
2
, Corinne GEPPERT
3
and Jürg SCHMIDLI
4
1) Inselspital Universitätspital Bern, Department of paediatric urology, Bern, SWITZERLAND - 2) University of Bern;
Inselspital Bern, Pediatric Urology, Department of Pediatric Surgery, Bern, SWITZERLAND - 3) University of Bern;
Inselspital Bern, Vascular Surgery, Department of Cardiovascular Surgery, Bern, SWITZERLAND - 4) University of Bern;
Inselspital Bern, Switzerland, Vascular Surgery, Department of Cardiovascular Surgery, Bern, SWITZERLAND
PURPOSE
The management of high-grade renal injury (IV-V; American Association for the Surgery of Trauma)
remains controversial, with a shift towards conservative treatment. Renal artery injury is a very rare
complication of blunt abdominal trauma in children.
MATERIAL AND METHODS
We present a case of an 11 year-old boy, who was admitted to the Pediatric Emergency Unit
after skiing accident. He was hemodynamically stable. Initial FAST ultrasound showed laceration
of the spleen (grade II) only. Further diagnostic revealed solitary rib fracture. Conservative treat-
ment was initiated. On the 2
nd
day routine follow-up with ultrasound showed retroperitoneal fluid.
MR-Urography was performed which revealed an occlusion of the left renal artery with diminished
perfusion of the kidney without urinary extravasation. As duplex sonography of the kidney showed
some perfusion, exploration and revascularisation of the vital kidney by aortorenal bypass with
reversed great saphenous vein was performed.
RESULTS
The left kidney showed immediate improvement of its perfusion. One week later the boy was
discharged with a patent bypass and well-perfused kidney. However after 4 months the left kidney
showed singes of atrophy with significant reduction of function, despite bypass with good perfusion
CONCLUSIONS
The management of this case remains controversial. Even with a successful surgical repair, the
best salvage rate for kidneys with pedicle injuries in ideal circumstances is reported with only 30%.
16:17–16:19
S3-14 (CP)
MANAGEMENT OF GRADE IV BLUNT RENAL INJURY:
CONSERVATIVE OR OPERATIVE?
Mazen ZEINO
1
, Milan MILOSEVIC
2
, Anna GEPPERT
2
and Steffen BERGER
2
1) Inselspital Universitätspital Bern, Department of paediatric urology, Bern, SWITZERLAND - 2) University of Bern;
Inselspital Bern, Pediatric Urology, Department of Pediatric Surgery, Bern, SWITZERLAND
PURPOSE
In hemodynamically stable children in the American Association for the Surgery of Trauma (AAST)
grade I to III injuries, success of conservative management has been well established. However
indication and timing of intervention versus conservative approach in grade IV Injuries remain
controversial.