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Traumatic Renal Injury in Pregnancy
Vol. 118, Novem.he;-
THE JOURNAL OF UROLOGY
Copyright © 1977 by The Williams & Wilkins Co.
Printed in U .SA
TRAUMATIC RENAL INJURY IN PREGNANCY ,JOHN F. REDMAN From the Department of Urology, University of Arkansas College of Medicine, Little Rock, Arkansas
ABSTRACT
The case is presented of a pregnant woman who had urinary extravasation from the right renal structures after an automobile accident. Treatment was conservative. complicating pregnancy have been reviewed previbut traumatic renal injury complicating pregnancy was not found. A case of a traumatic renal injury in a patient the eighth month of gestation is reported herein. 2
CASE REPORT
FIG. 1.
DISCUSSION
Although rare spontaneous rupture of the kidney and collecting structures as well as the spleen and liver has been reported in pregnancy." It would seem that the ectatic collecting structures associated with pregnancy would lend themselves frequently to tearing, possibly even in labor.
A. P., 18-74-58, a 15-year-old black primigravida, was hoswc,au,stu on October 23, 1976 immediately after an automobile
collecting
structures. On November 6 the patient delivered a normal infant vaginally.
demonstrates ectatic collecting structures on right side. Clot and extravasation are noted in and from upper pole B, !aminogTam shows detail of upper pole collecting structures.
accident. She was 8 months pregnant. The patient complained of mid thoracic back pain, mid sternal pain and right lower pain but she remembered striking the right there were no visible signs of the patient colored urine. An e>vrn,tn.ru urogram (IVP) demextravasation from the upper pole calices of the as well as right ureteropyelocaliectasis to the brim (fig. 1). Hematuria persisted for 3 days and the complained of right flank pain, which subsided after a There was no real evidence of flank fullness and labor was not initiated the trauma. An IVP 3 after injury demonstrated no evidence of extravasation 2). The fetus had moved from the right to the left side the left ~v'""''""'""' structures appeared more ectatic than the right Accepted for publication June 24, 1977.
urinary extravasation secondary to acute ureteral obstruction is not uncommon in non-pregnant patients only 6 instances of rupture of the renal collecting structures been noted during pregnancy. 3 A primary concern in this case was that with an obstmcter! ureter during pregnancy the urinary extravasation would continue, necessitating an early delivery. A change in fota1 position remedied the problem. Harrow and associates have presented good evidence that the dilated ureter nancy has a mechanical basis and they have ctemo,nstra complete return to normal size of moderately dilated urete,n: 24 hours postpartum. 4 Aaro and Kelalis summarized the management of renal pelvic rupture in pregnancy. 3 They indicated that treatment should include attempts to relieve the obstruction and drainage, followed by repair of the rupture if necessary. If the kidney is damaged severely nephrectorny should be done"
845
846
REDMAN
FIG. 2. IP shows change in fetal position as well as resolution of ectasia on right side REFERENCES
1. Dyer, I. and Barclay, D. L.: Accidental trauma complicating
pregnancy and delivery. Amer. J. Obst. Gynec., 83: 907, 1962. 2. Pepperell, R. J., Rubinstein, E. and Macisaac, I. A.: Motor-car accidents during pregnancy. Med. J. Aust., l: 203, 1977.
3. Aaro, L. A. and Kelalis, P. P.: Spontaneous rupture of the kidney associated with pregnancy. Amer. J. Obst. Gynec., 111: 270, 1971. 4. Harrow, B. R., Sloane, J. A. and Salhanick, L.: Etiology of the hydronephrosis of pregnancy. Surg., Gynec. & Obst., 119: 1042, 1964.
THE JOURNAL OF UROLOGY
Copyright © 1977 by The Williams & Wilkins Co.
Printed in U .SA
TRAUMATIC RENAL INJURY IN PREGNANCY ,JOHN F. REDMAN From the Department of Urology, University of Arkansas College of Medicine, Little Rock, Arkansas
ABSTRACT
The case is presented of a pregnant woman who had urinary extravasation from the right renal structures after an automobile accident. Treatment was conservative. complicating pregnancy have been reviewed previbut traumatic renal injury complicating pregnancy was not found. A case of a traumatic renal injury in a patient the eighth month of gestation is reported herein. 2
CASE REPORT
FIG. 1.
DISCUSSION
Although rare spontaneous rupture of the kidney and collecting structures as well as the spleen and liver has been reported in pregnancy." It would seem that the ectatic collecting structures associated with pregnancy would lend themselves frequently to tearing, possibly even in labor.
A. P., 18-74-58, a 15-year-old black primigravida, was hoswc,au,stu on October 23, 1976 immediately after an automobile
collecting
structures. On November 6 the patient delivered a normal infant vaginally.
demonstrates ectatic collecting structures on right side. Clot and extravasation are noted in and from upper pole B, !aminogTam shows detail of upper pole collecting structures.
accident. She was 8 months pregnant. The patient complained of mid thoracic back pain, mid sternal pain and right lower pain but she remembered striking the right there were no visible signs of the patient colored urine. An e>vrn,tn.ru urogram (IVP) demextravasation from the upper pole calices of the as well as right ureteropyelocaliectasis to the brim (fig. 1). Hematuria persisted for 3 days and the complained of right flank pain, which subsided after a There was no real evidence of flank fullness and labor was not initiated the trauma. An IVP 3 after injury demonstrated no evidence of extravasation 2). The fetus had moved from the right to the left side the left ~v'""''""'""' structures appeared more ectatic than the right Accepted for publication June 24, 1977.
urinary extravasation secondary to acute ureteral obstruction is not uncommon in non-pregnant patients only 6 instances of rupture of the renal collecting structures been noted during pregnancy. 3 A primary concern in this case was that with an obstmcter! ureter during pregnancy the urinary extravasation would continue, necessitating an early delivery. A change in fota1 position remedied the problem. Harrow and associates have presented good evidence that the dilated ureter nancy has a mechanical basis and they have ctemo,nstra complete return to normal size of moderately dilated urete,n: 24 hours postpartum. 4 Aaro and Kelalis summarized the management of renal pelvic rupture in pregnancy. 3 They indicated that treatment should include attempts to relieve the obstruction and drainage, followed by repair of the rupture if necessary. If the kidney is damaged severely nephrectorny should be done"
845
846
REDMAN
FIG. 2. IP shows change in fetal position as well as resolution of ectasia on right side REFERENCES
1. Dyer, I. and Barclay, D. L.: Accidental trauma complicating
pregnancy and delivery. Amer. J. Obst. Gynec., 83: 907, 1962. 2. Pepperell, R. J., Rubinstein, E. and Macisaac, I. A.: Motor-car accidents during pregnancy. Med. J. Aust., l: 203, 1977.
3. Aaro, L. A. and Kelalis, P. P.: Spontaneous rupture of the kidney associated with pregnancy. Amer. J. Obst. Gynec., 111: 270, 1971. 4. Harrow, B. R., Sloane, J. A. and Salhanick, L.: Etiology of the hydronephrosis of pregnancy. Surg., Gynec. & Obst., 119: 1042, 1964.