Management of combined renal and pancreatic trauma

During a 15-year period we treated 38 patients with combined renal and pancreatic injuries (40 kidneys): 18 patients (19 kidneys) with renal contusion (89% from blunt trauma) and 20 with renal laceration or vascular injuries (90% from penetrating trauma). All patients with renal contusion were managed conservatively without complication, despite major pancreatic injury in a third. The 16 patients with significant renal and pancreatic injuries were classified as a high risk group: 3 underwent nephrectomy for vascular injuries that could not be repaired but all of the remaining kidneys were salvaged. Perinephric abscesses developed in 2 of these patients, for a major complication rate of 15%. No secondary nephrectomies were necessary, nor did urinary fistulas develop. We conclude that significant renal injuries in patients with major pancreatic injuries may be managed by renal repair with an increased but acceptable complication rate and that nephrectomy should be performed only if the degree of renal injury precludes repair.