A 24-year-old man sustains blunt abdominal trauma in a road traffic accident. He is haemodynamically stable. CT shows a deep left renal laceration extending into the renal pelvis with extravasation of contrast, surrounded by a contained perirenal haematoma. There is no vascular injury. According to the AAST organ injury scale, this injury is graded as:

• A Grade IV ✓
• B Grade III
• C Grade II
• D Grade V

Explanation

Grade III denotes a laceration deeper than 1 cm without collecting system involvement. Extension of the laceration into the collecting system with urinary extravasation upgrades the injury to Grade IV, as do segmental vascular injuries with contained haemorrhage. Grade V is reserved for a shattered kidney or complete avulsion of the renal hilum with devascularisation. Since the patient is stable, Grade IV blunt renal injuries are managed conservatively with bed rest, serial haematocrit and repeat imaging.

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

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Written and medically reviewed by the StethoPrep medical team.