Genitourinary and Splenic Hemorrhage: We’re Important Organs Too!
Trauma to the genitourinary tract can affect the kidneys, ureters, bladder, and urethra. Of those, the kidneys are the most commonly injured organs with potential for significant blood loss. Considering this book’s focus on hemorrhage control, this chapter will therefore only discuss the management of kidney lacerations. In contrast to other solid organs, nonoperative management of high-grade renal lacerations is frequently successful and generally preferred. Isolated renal injuries causing hemodynamic instability are exceedingly rare, and a high index of suspicion should be maintained for the presence of associated injuries, particularly in blunt abdominal trauma. More often, kidney injuries are identified on abdominal computed tomography scan and can be managed nonoperatively with close monitoring and serial hemoglobin measurements. Intraoperatively, high-grade renal lacerations can present as zone II retroperitoneal hematoma and should only be explored in select circumstances.
The spleen is the most commonly injured organ in blunt trauma. Splenic injuries can be managed nonoperatively, with and without angiographic embolization, and operatively including splenorrhaphy, partial splenectomy, and splenectomy. Nonoperative management is more likely to be successful in isolated splenic injuries of low to moderate grade, while hemodynamic instability, peritonitis, and associated intracranial hemorrhage are absolute indications for splenectomy. In nonoperatively managed high-grade splenic injuries, follow-up should include repeat imaging to rule out the formation of pseudoaneurysms. After splenectomy the increased risk for infections in general, as well as the highly lethal postsplenectomy sepsis, requires attention.
KeywordsGenitourinary trauma Renal laceration Splenic laceration Nonoperative management Operative exposure
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