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