An 18-year-old male is brought in to the Emergency department after being stabbed in the right loin. There is no further history available. The patient’s blood pressure is poorly maintained with intravenous fluids but stabilises with a 2 unit blood transfusion. Contrast CT shows a Grade 4 Right renal injury. There is no suspected intra-abdominal injury. What is the next step in management?a. Request angioembolisation by experienced interventional radiologist
The so-called ‘ultraconservative’ approach to renal salvage should be followed in centres with the correct expertise. With the centralisation of trauma, these cases should not be managed in centres without 24 hours on call interventional radiology. Bleeding is the first priority and this should be controlled by selective angioembolisation. In the setting of urinary extravasation and penetrating trauma, embolisation should be followed by insertion of a ureteric stent. Unstable patients cannot be managed conservatively but operative intervention is likely to lead to nephrectomy.