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J Trauma Inj : Journal of Trauma and Injury



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Non-Operative Management with Angioembolization of Grade IV and V Renal Injuries in a Hybrid Emergency Room System
So Ra Ahn, Sang Hyun Seo, Joo Hyun Lee, Chan Yong Park
J Trauma Inj. 2021;34(3):191-197.   Published online September 30, 2021
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AbstractAbstract PDF

Renal injuries occur in more than 10% of patients who sustain blunt abdominal injuries. Non-operative management (NOM) is the established treatment strategy for lowgrade (I–III) renal injuries. However, despite some evidence that NOM can be successfully applied to high-grade (IV, V) renal injuries, it remains unclear whether NOM is appropriate in such cases. The authors report two cases of high-grade renal injuries that underwent NOM after embolization in a hybrid emergency room (ER) system with a 24/7 in-house interventional radiology (IR) team. A 29-year-old male visited Wonkwang University Hospital Regional Trauma Center complaining of right abdominal pain after being hit by a rope. Computed tomography (CT) was performed 16 minutes after arrival, and the CT scan indicated a grade V right renal injury. Arterial embolization was initiated within 31 minutes of presentation. A 56-year-old male was transferred to Wonkwang University Hospital Regional Trauma Center with a complaint of right flank pain. He had initially presented to a nearby hospital after falling from a 3-m height. Thanks to the key CT images sent from the previous hospital prior to the patient’s arrival, angiography was performed within 8 minutes of the patient’s arrival and arterial embolization was completed within 25 minutes. Both patients were treated successfully through NOM with angioembolization and preserved kidneys. Hematoma in the first patient and urinoma in the second patient resolved with percutaneous catheter drainage. The authors believe that the hybrid ER system with an in-house IR team could contribute to NOM and kidney preservation even in high-grade renal injuries.



Citations to this article as recorded by  
  • Endovascular embolization of persistent liver injuries not responding to conservative management: a narrative review
    Simon Roh
    Journal of Trauma and Injury.2023; 36(3): 165.     CrossRef
Artery to Collecting System Communication after Abdominal Trauma
Chang Ug Lee, O Jung Kwon, Sung Hak Bang, Nak Young Choi, Chang Sub Lee, Seung Hyun Ahn
J Korean Soc Traumatol. 2006;19(2):192-195.
  • 1,108 View
  • 1 Download
AbstractAbstract PDF
Degenerative vascular disease, previous arterial surgery, long-term ureteral stenting, pelvis surgery, and radiotheraphy are reported as causes of artery-to-collecting-system communication.. Artery-to-collecting-system- communication associated with blunt trauma is rare, but potentially fatal. The diagnosis is very difficult and requires a high degree of suspicion. We were able to make the diagnosis based on the characteristic finding of contrast-enhanced computed tomography (CT) obtained in the early phase, equivalent to the finding obtained in the corticomedullary phase of the kidney. We report a case of artery to collecting system communication due to blunt abdominal trauma following a fall, which was treated by embolization.

J Trauma Inj : Journal of Trauma and Injury