e-CASES: Renal vein rupture, Adrenal hemorrhage
23-year old patient, high-speed road traffic accident, rear passenger, in hemorrhagic shock on the arrival of the emergency services. The body scan performed after hemodynamic stabilization is provided.
- No posttraumatic lesions in the cranioencephalic, spinal, and thoracic spaces.
- Massive right hemoretroperitoneum with intraperitoneal contamination due to probable rupture of the right renal vein with active bleeding. Delayed secretion and no excretion from the right kidney with contusions of the upper and inferior poles. Delayed excretion to the left; it is thus not possible to rule out trauma to the excretory system. Small 4 mm thrombus of the left renal vein.
- Hematoma on the right adrenal gland with no active bleeding.
- Infiltration and tumefaction of the greater omentum (contusion?).
- Hypo-dense striations of the head of the pancreas, to be monitored closely as this is suggestive of pancreatic lacerations.
- No other posttraumatic lesions of the intra-abdominal organs.
Renal vein rupture, Adrenal hemorrhage
The patient underwent immediate surgery confirming rupture of the right renal vein, which could not be sutured. A right nephrectomy and adrenalectomy were therefore performed to achieve hemostasis. The remainder of the perioperative traumatic evaluation revealed contusion of the greater omentum (with no repercussions on gastrointestinal vitality, standard monitoring) with no other traumatic lesions of the intra-abdominal organs (and notably an intact pancreas).The patient's kidney function was normal in the postoperative phase.
- Active bleeding that is visible in the arterial phase is of arterial origin, but active bleeding that is visible in the portal phase may be of arterial or venous origin (as arteries often go into spasm following injury, or the patient may be in hypovolemic shock resulting in delayed vascular opacification).
- In the absence of urinary excretion, it is not possible to rule out trauma to the excretory system, particularly if hemoretroperitoneum is also observed.
- Be aware of normal anatomical bone variants so as not to mistake them for traumatic lesions.
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