A 32-year-old male presented to the ER with complaints of abdominal pain, giddiness, and vomiting. Attendants gave an alleged history of assault where the patient was beaten up over the abdomen.
On examination, the abdomen was distended and diffuse tenderness was present.
The patient had a CECT abdomen scan which was suggestive of a grossly dilated left kidney with retroperitoneal hematoma with grade IV Renal injury and PUJ obstruction with a thin rim of parenchyma. The mass was abutting the aorta and inferior vena cava and pushing them to the right side. A decision of renal arterial embolization before open nephrectomy was planned to reduce blood loss.
Renal angio- contrast leakage from middle segmental artery. Post-embolization with no contrast leak
Because of poor functioning large dilated left kidney, with mass effect on large vessels and persistent pain, he underwent exploratory laparotomy and left nephrectomy with the evacuation of the retroperitoneal hematoma. The Postoperative course was uneventful and was discharged on POD 7. The concept of damage control has gained popularity and many patients and significantly reduced Morbidity. Recent advances in the management of vascular injuries have significantly reduced morbidity by controlling early surgical bleeding. Renal angiogram and embolization of the leaked vessel were performed before the surgery. In Our case, the patient presented to us with renal artery injury and continuous bleeding in the abdomen cavity. The availability of vascular surgeons in our facility has a profound effect on patient's life and significantly reduced morbidity.
