Case Presentation 32yr old man admitted post Motor Vehicle Crash. On admission : Primary survey Airway : Maintaining own airway.  Cervical collar & immobilisation in place Breathing : Respiratory rate 20, right sided chest bruising, clinically multiple right sided rib fractures. O2sats 96% Circulation : Pulse 120/min, BP 80/40 Disability : Glasgow Coma Score 14/15.  Bilateral equal pupils.  No gross peripheral motor or sensory deficit. Exposure : No other obvious injuries.

Introduction Case Presentation Initial Evaluation Radiology Grading Management Surgical Technique Conclusions

Chest X-Ray showed multiple right sided rib fractures and pneumohaemothorax.
Right intercostal chest drain inserted
Cervical spine and pelvis X-rays normal.

Secondary Survey

Showed distended abdomen, with pain and tenderness in the right flank.
Macroscopic haematuria following urethral catheterisation.
No other injuries detected.

Resuscitation room intravenous urography was performed:

Demonstrating extravasation of contrast from the right kidney, and a functioning left kidney.

Surgery

Patient was taken for laparotomy, where he was found to have a 500mls of free blood in the peritoneum.  There was no injury to intraperitoneal organs, but a large, expanding retroperitoneal haematoma was present, which was leaking into the peritoneal cavity.

The retroperitoneum was opened, revealing an large laceration to the lower pole of the right kidney:

Devitalised tissue was debrided, and the kidney repaired with pledgeted mattress sutures across both ends of the laceration.

A drain was placed to the retroperitoneum and the abdomen closed.
The patient had an uneventful postoperative course and was discharged home on day 8.