ABDOMINAL AND PELVIC TRAUMASurgical Emergencies 2434 Insert a large-bore i.v. cannula and send blood for FBC, U&Es and cross-
match 2–6 units of blood.
5 Request a thoracolumbar spine X-ray to exclude bony trauma.
6 Proceed to radiological imaging of the kidney and ureters. Indications
include:
(i) Significant deceleration injury with the risk of renal pedicle
injury.
(ii) Local physical signs.
(iii) Macroscopic haematuria.
(iv) Microscopic haematuria with shock (systolic blood pressure
≤90 mmHg) at any time.
(v) Penetrating proximity trauma (see below).
7 Request a CT scan with i.v. contrast to evaluate suspected renal injury in the
presence of any of the above. It has replaced the intravenous pyelogram
(IVP).
MANAGEMENT1 Resuscitate the patient with i.v. f luids and exclude associated intra-
abdomina l injuries wit h ultrasound (FAST) or CT.
2 Refer the patient to the surgical team for admission and observation. Over
85% of blunt renal injuries settle on conservative management with bed rest
and analgesia.
Penetrating renal injury
DIAGNOSIS
1 These are rare and usually involve injury to the abdominal contents, ureter
or vertebral column. They may be multiple or associated with penetrating
anterior truncal injury.
2 There is usually haematuria, localized pain, and tenderness, although signif-
icant renal or ureteric injury may be present without haematuria.
3 Ureteric colic can occur from the passage of blood clots.
4 Insert a large-bore i.v. cannula and send blood for FBC, U&Es, and cross-
match 2–4 units.
5 Perform special imaging with a CT scan with i.v. contrast (or an IVP if that is
all that is available).
(i) These demonstrate the nature of the renal injury and also
confirm the presence and normal function of the other kidney.
(ii) CT scan gives essential additional information on intra- or
retroperitoneal injury.