Surgical management of pediatric renal trauma: an urban experience

This study was undertaken to review our operative experience in the management of pediatric renal trauma. Over a 2-year period (August 1988 to August 1990) 25 of 60 children undergoing celiotomy sustained renal injuries. There were 22 boys and three girls ranging in age from 5 to 18 years. Eighty-four per cent were victims of gunshot wounds, 12 per cent were stabbed, and 4 per cent sustained blunt trauma. The 25 injured children sustained a total of 45 individual organ injuries. Only 16 per cent required a nephrectomy, while the great majority (84%) were managed with renal sparing procedures. When we compared survivors to nonsurvivors, there was more thoracic and vascular injury along with more blood transfusion requirements in nonsurvivors. There was no statistical difference in Pediatric Trauma Score (PTS) between survivors and nonsurvivors (9.8 +/- 0.26 vs 9.5 +/- 1.5). Preoperative intravenous pyelographies (IVPs) performed in 52 per cent of all patients demonstrated the site of injury, presence of contralateral function as well as the anatomic position of the kidneys. We conclude that renal injury is common following penetrating abdominal trauma in childhood, however, these injuries can be managed by early operation with renal sparing procedures. There is a high incidence of associated intra-abdominal injury in those who have sustained penetrating renal trauma, but mortality is more common in patients sustaining associated thoracic and vascular injuries. An IVP should be performed, even in the absence of hematuria, when trauma trajectory strongly suggests urologic injury. This study also illustrates the sharp rise in drug-related urban violence with an associated increase in pediatric renal trauma.