Delayed Traumatic Renal Artery Occlusion: Report of a Case

遲發創傷性腎臟動脈阻塞：病例報告

陳偉雄(Wai-Hung Chan) ； 黃弘哲(Hung-Che Huang) ； 陳恆中(Heng-Chung Chen) ； 詹健彬(Chien-Pin Chan)

《Formosan Journal of Surgery》 44卷2期 (2011/02) Pp. 59-64

https://doi.org/10.29833/FJS.201102.0019

摘要

腹部鈍傷引起之腎臟血管損傷，並不常見，故未見較理理想之一般處理方式，早期診斷及處理之方法包括腎臟切除、血管重建、注射血栓溶解劑、血管內支架置放及保守治療等．．．。本個案為60歲男性，三天前因車禍引起胸腹部挫傷併左胸腹疼痛，於他院治療後，當日返家，因有持續性血尿，至本院急診求治，其生命跡象穩定，腹部電腦斷層證實有左腎臟出現血管阻塞現象，懷疑腎動脈部分剝離，經建議後施行血管攝影及血管內支架置放，第一次血管攝影完成，證實腎臟阻塞情形漸趨嚴重，而第二次血管攝影，證實左腎臟動脈完全阻塞，持續採保守性治療，並未產生相關併發症，三天後出院持續門診追蹤，早期診斷及提早治療，為鈍傷引起腎臟血管損傷治療之不二法則，腹部電腦斷層具高敏感度及高專一性，為最佳之診斷工具...。

並列摘要

Traumatic renal artery injury is an unusual result of blunt trauma. No meaningful recommendation has been established for optimal management of blunt renal artery injury on account of a small number of cases. Early diagnosis, however, is important and advocated early management at present includes nephrectomy, revascularization, endovascular stenting, thrombolytic agent administration and careful observation of blunt renovascular injuries.A 60 year-old male suffered from a traffic accident when he drove a car and hit a telephone pole three days before. He was brought to the emergency department of a local hospital for first aid. He was then discharged to go home. However, gross hematuria was noted three days later and he came to our hospital. His vital signs were relatively stable at that time. (heart rate: 96/min, blood pressure 120/88mmHg, body temperature 36.7°C and respiratory rate: 18/min). Poor contrast perfusion in the left kidney was revealed on abdominal computed tomography. Dissecting injury of the renal artery was suspected. After performance of the first arteriography showing left renal artery occlusion, renal artery occlusion progressed and the lumen could not be identified during the second arteriography, which revealed total occlusion of the left renal artery. The patient received conservative therapy, and there was no further complication during his follow up at the outpatient department. Early diagnosis and early management will result in better recovery of the renal function. Computed tomography scan can be considered as the first choice of examination for diagnosis because of its high sensitivity and specificity.

並列關鍵字

traumatic renal artery injury ； renal artery occlusion ； arteriography