Urological Causes of an Acute Abdomen

Dr Charles Chabert

Renal Trauma

1-5% of all Trauma

50% all GU Trauma

Both kidneys equally affected

Majority blunt trauma

Renal Trauma

Haematuria

Absent in 40% pedicle injuries

Does not differentiate minor from major

Renal Imaging

Who and How?

Contrast CT

Unstable patients - One shot IVP

Injury Scaling

1. Subcapsular haematoma

2. Cortical laceration <1cm

3. Cortical laceration >1cm

4. A. Cortical laceration into collecting system

B. Vascular injury with contained haematoma

5. A. Shattered kidney

B. Avulsion

Organ injury Scaling AAST

Renal Trauma

Renal Trauma – grade 5

Renal Trauma

Renal Trauma

Grade 5

Grade 5

Gunshot injury

Gunshot injury

Gunshot injury

Indications For Exploration

Persistent , life threatening haemorrhage

Pulsatile, expanding haematoma

Grade 5 injuries

Ureteric Colic

Pain

Haematuria

Sepsis

Ureteric Colic

Urinalysis

FBC, EUC

Imaging: CT scan & KUB Xray

Ureteric Colic

Ureteric Colic

Ureteric Colic

Management

Analgesia

Hydration

Drainage renal unit:Pain

SepsisDeteriorating renal function

Single system

Ureteric Trauma

< 1% renal trauma

Iatrogenic more common

Paediatric trauma - PUJ

Bladder Trauma

Extraperitoneal or intraperitoneal

Extra- associated with pelvic fracture

Intra- associated with deceleration

Bladder Trauma

Suprapubic pain

Haematuria

Retention

Peritoneal irritation

Bladder trauma

Cystogram

CT Cystogram

Pevic X Ray

Extraperitoneal Rupture

Bladder Trauma

Principles of Treatment

Urethral drainage

Exploration and formal repair

Summary

Urological trauma is rare

Treatment conservative

Stones – unilateral

Drainage for:

Pain

Sepsis

Deterioration renal function