Experiencia de traumatismo renal abierto en un Servicio de Urología

Resumen

Introducción

El traumatismo renal abierto alcanza en zonas urbanas entre un 15-20% del total de traumatismos renales. Es producido principalmente por armas blancas o de fuego; estas últimas son de alta energía y se asocian a lesiones en otros órganos. Se presenta nuestra experiencia en traumatismo renal abierto en los últimos 24 meses.

Material y métodos

Estudio retrospectivo. Se evaluaron los pacientes con traumatismo torácico, abdominal y toracoabdominal ingresados entre julio de 2009 y junio de 2011. Se identificaron 14 pacientes con diagnóstico de traumatismo renal abierto con confirmación diagnóstica por imágenes o durante el intraoperatorio.

Resultados

Las edades oscilan entre 16 y 37 años, con un promedio de 24,5; 13 casos de 14 fueron hombres. El mecanismo del traumatismo es en un 71% (10/14) por arma de fuego y en un 29% (4/14) por arma blanca. Se clasificó el traumatismo renal según la American Association for the Surgery of Trauma, encontrándose que 3/14 (21%) corresponden a grado II, 4/14 (29%) a grado III, 4/14 (29%) a grado IV y 3/14 (21%) a grado V. El descenso de hematocrito varió entre el 1 y 27%, con un promedio de 13,9%. Se decidió un manejo conservador en 6/14 pacientes, considerándose como tal las cirugías efectuadas por lesión de órgano no urológico. Un total de 6 pacientes (42%) requirió nefrectomía. Hubo lesiones toracoabdominales asociadas en el 79%.

Conclusiones

A pesar de la baja incidencia de traumatismo renal abierto, se observa un gran número de pacientes considerando otras series nacionales. Lo anterior probablemente sea debido a las características socioculturales del centro hospitalario.

Abstract

Introduction

Opened renal trauma in urban areas reaches 15 to 20% of all renal traumas. It is mainly caused by gunshot wounds or knifes. Gunshot wounds are classified as high energy trauma and are usually associated to other organ injuries. We present our experience in opened renal trauma in the last 24 months.

Material and methods

Retrospective study: patients with thoracic, abdominal and thoraco-abdominal trauma admitted to the emergency room between July 2009 and June 2011 were studied. Fourteen patients were identified with opened renal trauma, with diagnostic confirmation by imaging study or during surgery.

Results

Ages ranged from 16 to 37 years, with a mean age of 24.5 years. Thirteen patients were males. The mechanism of injury was produced by gunshot in 71% (10/14) and by knife in 29% (4/14). The opened renal traumas were classified according to the American Association for the Surgery of Trauma. Of these, 3/14 (21%) belonged to grade II, 4/14 (29%) to grade III, 4/14 (29%) to grade IV and 3/14 to grade V (21%). Fall in hematocrit ranged from 1% to 27%, with an average of 13.9%. Expectant management was done in six patients, however, this management did not take into account those surgeries performed due to non-urologic organ injuries. Six patients (42%) required nephrectomy. Thoraco-abdominal injuries were associated in 11 patients (79%).

Conclusions

Despite the low incidence of opened renal trauma, many patients are observed when other national reports are considered, probably due to the socio-cultural characteristics of this hospital.