腎動脈損傷を伴う右腎単純深在性損傷に対して保存的治療が奏効した1例

Abstract

An octogenarian male presented to the emergency department following a fall. On admission, his systolic blood pressure was in the 70s mmHg range, and his pulse was around 60 bpm. Initial resuscitation efforts included fluid administration with normal saline and vasopressor support with noradrenaline. A contrast-enhanced abdominal computed tomographic (CT) scan revealed multiple simple intraparenchymal lacerations in the right kidney, accompanied by perinephric hematoma, and peripheral extravasation of contrast at the right renal artery. There was also partial luminal narrowing of the main right renal artery, raising concern for the development of a false lumen. The renal injury was classified as grade IIIa, PV, H1, according to the Japanese Association for the Surgery of Trauma (JAST) criteria. Although interventional radiology (IVR) was considered for management of perinephric hematoma, it was ultimately deemed inappropriate given the potential presence of a false lumen in the main right renal artery. The patient's hemodynamic status improved, and vasopressors were discontinued by the time of the follow-up CT scan. Despite subsequent imaging showing hematoma enlargement, the patient remained hemodynamically stable, and conservative management was chosen. During hospitalization, the patient required transfusion of 16 units of packed red blood cells, 10 units of platelet concentrate, and 20 units of fresh frozen plasma. Gradual mobilization began six days after admission, and the patient was discharged on day 15. The follow-up contrast-enhanced abdominal CT one-month post-injury showed no evidence of pseudoaneurysm, and the renal function remained preserved throughout the course of care.