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Revista do Colégio Brasileiro de Cirurgiões

Print version ISSN 0100-6991

Rev. Col. Bras. Cir. vol.26 no.1 Rio de Janeiro Jan./Feb. 1999

https://doi.org/10.1590/S0100-69911999000100012 

ARTIGO DE REVISÃO

 

Trauma renal

 

Renal trauma

 

 

Gerson Alves Pereira Júnior, ACBC-SPI; Fernando PaganelliII; Sandro Scarpelini, TCBC-SPIII; Luís Donizetti Silva Stracieri, TCBC-SPIII; Ornar Féres, TCBC-SPIII; José Ivan de Andrade, TCBC-SPIV

IMédico Assistente do Departamento de Cirurgia, Ortopedia e Traumatologia
IIAluno da Graduação da FMRP-USP
IIIMédico Assistente do Departamento de Cirurgia, Ortopedia e Traumatologia. Mestre em Cirurgia pela FMRP-USP
IVProfessor Doutor do Departamento de Cirurgia, Ortopedia e Traumatologia. Diretor da Unidade de Emergência do Hospital das Clínicas da FMRP-USP

Endereço para correspondência

 

 


RESUMO

Apresentamos uma revisão sobre trauma renal, com ênfase na avaliação radiológica, particularmente com o uso da tomografia computadorizada, que tem se tornado o exame de eleição, ao invés da urografia excretora e arteriografia. O sucesso no tratamento conservador dos pacientes com trauma renal depende de um acurado estadiamento da extensão da lesão, classificado de acordo com a Organ Injury Scaling do Colégio Americano de Cirurgiões. O tratamento conservador não-operatório é seguro e consiste de observação contínua, repouso no leito, hidratação endovenosa adequada e antibioti- coterapia profilática, evitando-se uma exploração cirúrgica desnecessária e possível perda renal. As indicações para exploração cirúrgica imediata são abdome agudo, rápida queda do hematócrito ou lesões associadas determinadas na avaliação radiológica. Quando indicada, a exploração renal após controle vascular prévio é segura, permitindo cuidadosa inspeção do rim e sua reconstrução com sucesso, reduzindo a probabilidade de nefrectomia.

Uniterrnos: Trauma renal; Tomografia computadorizada.  


ABSTRACT

We present a revision of the renal trauma with emphasis in the radiographic evaluation, particularly CT scan that it has largely replaced the excretory urogram and arteriogram in the diagnostic worh-up and management of the patient with renal trauma. The successful management of renal injuries depends upon the accurate assessment of their extent in agreement with Organ Injury Scaling classification. The conservative therapy managed by careful continuous observation, bed rest, appropriate fluid ressuscitation and prophylactic antibiotic coverage after radiographic staging for severely injured kidneys can yield favorable results and save patients from unnecessary exploration and possible renal loss. The indications for immediate exploratory laparotomy were acute abdomen, rapidly dropping hematocrit or associated injuries as determinated from radiologic evaluation. When indicated, renal exploration after trauma is safe and in a high percentage of cases reconstruction will be successful. Isolation of the renal vasculature before exploration of the renal trauma is believed to reduce blood loss, allow for more careful and confident renal inspection and reconstruction, and reduce the probability of  nephrectomy.

Key words: Renal trauma; Kidney; Trauma; Wounds and injuries; Tomograph.


 

 

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

 

 

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Endereço para correspondência:
Dr. Gerson Alves Pereira Júnior
Hospital das Clínicas FMRP-USP Unidade de Emergência
Rua Bernardino de Campos, 1.000
14015-130 - Ribeirão Preto - SP

Recebido em 3/4/98
Aceito para publicação em 9/11/98

 

 

Trabalho realizado na Unidade de Emergência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo - FMRP-USP.

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