A 30-year-old man sustains a blunt abdominal trauma in a road traffic accident. He is haemodynamically stable. Contrast-enhanced CT shows a deep laceration of the left kidney extending into the collecting system with a perinephric haematoma but no vascular pedicle injury. There is no urine leak on delayed films. What is the most appropriate initial management?
- A Conservative management with bed rest and serial monitoring ✓
- B Immediate exploratory laparotomy and renal repair
- C Immediate nephrectomy
- D Angioembolisation of the renal artery
Correct answer: A. Conservative management with bed rest and serial monitoring
Explanation
This is an AAST Grade IV renal injury (laceration extending into the collecting system) in a haemodynamically stable patient. The standard of care is conservative management with bed rest, serial haemoglobin monitoring and repeat imaging, because over 90 percent of stable renal injuries can be managed non-operatively. Exploration is reserved for haemodynamic instability, expanding haematoma or associated intra-abdominal injuries requiring laparotomy. Angioembolisation is used for active contrast extravasation or secondary haemorrhage, not as first-line here.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.