Login to Access Video or Poster Abstract: MP79-03
Sources of Funding: none

Introduction

Concurrent colon injury in the setting of renal trauma has historically resulted in concern for increased morbidity from genitourinary complications. Sparse data exist on the management of renal trauma in the setting of colon injury, especially in the era of conservative management. This study investigates the effect of concurrent colon injury on the management and morbidity of renal trauma.

Methods

An institutional trauma registry was queried between the years of 2005 and 2015. All patients with concurrent renal and colon trauma were retrospectively isolated and reviewed. Patient characteristics such as age, renal injury grade, mechanism, need for immediate exploration and urology consultation was noted. Grade of renal injury was stratified according to AAST criteria and was staged via computed tomography imaging or operative examination. If applicable, the type of genitourinary intervention performed was also noted. Complication rates were compared between patients who underwent genitourinary intervention and those that did not.

Results

A total of 45 patients were included, with the average age of 33 years (16-71 yrs). The slight majority presented with penetrating injury (53%). Immediate abdominal exploration occurred in 51% of patients. Urologic consultation occurred in only seven (15.5%) patients. However, 20 patients underwent urologic intervention, with nephrectomy and renorrhaphy being most common. In total, 13 nephrectomies (29%) were performed, all for high-grade (Grade 4-5) injuries. All nephrectomies were performed by trauma service without urology involvement. Overall complication rate was 57%. Differences in total complication rate were not found to be statistically significant based on genitourinary intervention. No urology specific complications (urinary tract infection, pyelonephritis, perinephric abscess, urinoma) were observed in low-grade (Grade 1-3) renal injuries that were conservatively managed (N=20).

Conclusions

Urologic intervention for renal trauma with concurrent colon injury does not reduce the risk of complication. Low-grade renal injuries can still be managed expectantly without increasing risk of genitourinary complication. High-grade injuries are at increased risk for nephrectomy. Larger, multi-institutional studies are warranted to determine viability of expectant management or intraoperative urology consultation in high-grade renal injuries with concurrent colon injury.

Funding

none