Superselective angioembolization of segmental renal artery in grade 4 renal trauma: A case report

Genitourinary tract injury is involved in around 10% of blunt abdominal trauma, with the kidney accounting for most cases. Surgical treatment in the form of exploration has been traditionally used to control bleeding. Newer advances in interventional radiology, with improvement in precise imaging and the localization of bleeding vessels, have led to a high success rate of angioembolization. We describe here a case of grade 4 right renal injury that underwent successful superselective angioembolization of the renal artery. A 26-year-old male presented to the emergency department of the trauma center, All India Institute of Medical Sciences, Patna with an alleged history of road traffic injury. A contrast-enhanced CT abdomen was done, which showed grade 4 right renal injury with active contrast leak from the branch of the right renal artery. On post-injury day 1, he had a drop in hematocrit/hemoglobin. He also had more progressive hematuria. He was shifted to the digital subtraction angiography room, where imaging showed contrast extravasation from a branch of the right middle segmental renal artery. There was no contrast extravasation seen after coil embolization. He was discharged after 1 week of hospital stay. He came for follow-up after 4 weeks, where a renal function test was normal and repeat ultrasonography of the abdomen showed a focal defect with scarring of the right renal mid-pole, along with mild right pyelectasis and maintained vascularity at all renal poles. The major cause of bleeding after renal trauma is due to rupture of the renal artery and its branches. Such a patient undergoes a routine CT with contrast to determine the source and grade of renal injury. Such cases are now best managed using superselective angioembolization, depending on the availability of interventional radiology.