A 25-year-old man sustains blunt abdominal trauma in a road traffic accident. CT shows a left renal laceration extending through the cortex and medulla into the collecting system with contrast extravasation, but he is haemodynamically stable and there is no other organ injury. What is the preferred management?

• A Immediate open renal exploration and repair
• B Nephrectomy
• C Conservative management with bed rest, serial haematocrit and repeat imaging ✓
• D Selective renal artery embolisation

Explanation

Modern practice is conservative management for most blunt renal injuries, including higher-grade lacerations, provided the patient is haemodynamically stable and there is no expanding perirenal haematoma or associated injury mandating laparotomy. Serial haematocrit monitoring, bed rest until macroscopic haematuria clears and follow-up imaging are standard. Exploration risks nephrectomy and increases the rate of renal loss. Embolisation is mainly for active arterial bleeding or delayed haemorrhage, not a stable patient whose bleeding has stopped.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

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