Conservative management of high-grade pediatric renal trauma: Report of two clinical cases

Abstract

ABSTRACT

Trauma is one of the leading causes of morbidity and mortality in pediatrics. Renal trauma accounts for 1–5% of all traumatic injuries and is the most common traumatic injury to intra-abdominal solid organs. In the last decade, conservative management of traumatic solid organ injuries has become standard practice. We present two pediatric patients managed conservatively for high-grade renal trauma. Case 1: A 9-year-old male with no prior medical history presented with right lumbar contusion following a fall from a 2-meter-high tree. He was admitted with gross hematuria, severe pain, and hemodynamic stability. Contrast-enhanced abdominal CT scan revealed a grade IV renal injury. Conservative management included analgesia, maintenance intravenous hydration, antibiotic therapy, rest, and placement of a double J ureteral stent. The patient was discharged after 11 days and scheduled for outpatient follow-up in 2 months. Follow-up CT showed favorable progression, with the patient remaining asymptomatic and with preserved renal function. Case 2: A 10-year-old school-aged male with no relevant medical history presented with right thoracoabdominal trauma after falling into a 5 meter-deep ravine. He reported severe right flank pain, exhibited voluntary guarding, was hemodynamically stable, and had no respiratory compromise. Abdominal ultrasound showed a right perirenal hematoma, and a contrast enhanced CT revealed a grade V right renal injury. Conservative treatment included maintenance hydration, antibiotics, analgesia, rest, and placement of a double J stent. The patient was discharged and followed up one month later. Control CT showed favorable evolution, and the patient remained asymptomatic. Conservative management of renal injury in hemodynamically stable pediatric patients is effective when cases are properly individualized and the injury grade is accurately classified.