Management of renal stab wounds by arteriographic embolisation

A 26 year old man was admitted with multiple stab wounds to his chest, abdomen and right loin. He was noted to have a large haemothorax, a tender abdomen and frank haematuria. At laparotomy, there was a small non expanding retroperitoneal haematoma that was not explored, and no visceral damage. Post operatively he continued to have haematuria. IVP and ultrasound showed perirenal haematoma and clot in the upper pole calyces but was otherwise normal. Renal arteriography demonstrated a pseudo-aneurysm in the right mid region, feeding an arteriovenous fistula (Figure 1). Selective renal artery embolisation with spring occlusion coils was performed which occluded the branch supplying the false aneurysm and fistula (Figure 2). He had no further haematuria. At six month follow up he remained well, normotensive and with no haematuria. Isotope renogram showed 30% loss of function at the upper pole.