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Renal trauma secondary to stab, blunt and firearm injuries--a 5-year study
T E Madiba1, A A Haffejee, J John
1Department of Surgery, University of Natal and King Edward VIII Hospital, Durban.
Objective:
To review our experience of renal trauma at King Edward VIII Hospital, Durban.
Design:
Retrospective study over 5 years.
Setting:
Tertiary referral hospital in an urban area.
Patients:
One hundred and seventy-four patients presenting with renal injuries treated at King Edward VIII Hospital.
Interventions:
One hundred and thirty-six patients underwent laparotomy, while 38 were managed conservatively.
Results:
There were 174 patients with renal injuries (148 male, median age 26 years). Eighty-seven injuries were from firearms, 43 from stabs and 44 from blunt trauma. Of 136 patients who underwent surgery, 60 were managed conservatively at laparotomy, 26 underwent renorrhaphy, 40 nephrectomy and 10 heminephrectomy. There was a 33% complication rate following surgery. The mortality rate was 20% (24%, 21% and 12% for firearm, stab and blunt injuries, respectively). There was no statistically significant difference in mortality for firearm, stab and blunt injuries. Furthermore, there was no difference in mortality and morbidity between those with associated organ injuries and those with isolated injuries (29% v. 21% and 30% v. 16%, respectively), but the difference in mortality became significant when patients with isolated injuries who did not undergo surgery were included (P = 0.0083).
Conclusion:
Renal injuries either in isolation or in association with other injuries carry a high mortality and morbidity rate. Firearm injury patients have a large number of associated injuries and have the highest complication rate. Operative strategy should be conservative unless the kidney is unsalvageable.