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CONGRESS OF THE ESPU
MATERIAL AND METHODS
We present a case of a 7-year-old boy with an unusual clinical course after isolated blunt renal
trauma, which initially was treated conservatively. Imaging showed grade IV injury without urinoma
but diminished perfusion of the lower part of the kidney. Slight hematuria stopped after 5 days and
the child remained hemodynamically stable. 12 days after trauma ultrasound showed some lique-
faction of the hematoma, MR-Urography excluded urinoma and no stent was necessary. 2 days
later sudden gross hematuria with flank pain occurred, accompanied by hemodynamic instability,
an active bleeding in the kidney with large bladder tamponade was found in FAST ultrasound.
Immediate exposure of the kidney was performed and kidney sparing surgery by heminephrectomy
and reconstruction of renal pelvis was possible.
RESULTS
A follow up by Imaging and renal DMSA scan showed a successful outcome with good function of
the residual kidney.
CONCLUSIONS
Most children with grade IV renal injury are treated using a conservative approach with a high suc-
cess rate. However delayed renal bleeding with hemodynamic instability is rare but can cause a life
threatening condition which requires an emergency exposure that mostly ends in nephrectomy.
16:19–16:21
S3-15 (CP)
BILATERAL PERINATAL TESTICULAR TORSION –
A CASE REPORT
Martina FRECH, Vivienne SOMMER and Frank-Martin HÄCKER
University Children’s Hospital Basel, Pediatric Surgery, Basel, SWITZERLAND
PURPOSE
Perinatal testicular torsion is a rare condition, especially if both testicles are affected.
MATERIAL AND METHODS
We present a newborn boy, who was transferred to our Department at an age of 6 hours. He was
delivered at 40 weeks of gestation out of breech presentation.
RESULTS
Shortly after birth, a painful swelling and discoloration of the scrotum was noticed. Clinical examina-
tion as well as immediately performed ultrasound was highly suspicious for testicular torsion of the
right side. We decided for emergency surgery and took the boy to the operating theatre. During
operation, we found a bilateral testicular torsion with dark coloration of both testicles. After packing
for about 15 minutes, the right side seemed to recover slightly. The testicles were left in situ and
bilateral orchidopexy was performed. After 2 days, ultrasound examination showed reperfusion of
both testicles and the boy was discharged from hospital. Follow-up was done after 2 months, where
we had normal clinical examination and sonographically persistent perfusion of both testicles.
Endocrinological investigation during minipuberty showed normal hormonal values. Further follow-
up after 6 months is scheduled.
CONCLUSIONS
We would like to present this rare case in regard to the current literature and encourage surgeons
to consider carefully leaving the testicles in situ.