Answer: Either A or B may be appropriate since this is a Grade II injury based on CT criteria.
- The determination of whether to observe a patient with solid organ injury or to attempt to surgical repair is based on clinical outlook, serial blood tests and imaging. The CT classification for renal trauma divides injuries into 4 grades.
- Grade I is a superficial laceration and is typical observed.
- Grade II injuries are deep corticomedullary lacerations, as seen in this case, where the laceration extends anterior to posterior at midline where the kidney was compressed against the spine.
- Grade III is a renal crush injury or one in which the vascular pedicle is involved and
- Grade IV is an injury that extends into either the renal pelvis or ureteropelvic junction.
- Both Grade III and IV injuries are treated surgical as hemostasis and preservation of renal function are unlikely to occur without intervention.
- The finding of blood in the bladder or retroperitoneum by itself is not an indication for surgery. In fact, hematuria is a common finding in renal trauma occurring in approximately 95% of the time.