Delayed nephrectomy in grade V renal injury with two interesting anatomic variations

The decision to perform early nephrectomy in hemodynamically stable grade V injury rather than to provide supportive nonoperative care is not universally accepted. The management of isolated grade V renal injury, as well as the management of coexisting abdominal trauma that requires operative intervention, is an area of controversy. We present the case of a grade V renal injury that was initially managed expectantly at a level I trauma center. After transfer to our facility, nephrectomy was performed. The case illustrates the merit of prompt definitive surgical treatment.