Abstract
The patient was a 81-year-old woman, who had been carried into our hospital after having been hit by a small truck. The accident occurred when she was crossing a street. Her major complaints were gross hematuria and left abdominal pain. Computerized tomography was performed with contrast medium. In light of the Japanese classification of renal trauma, we diagnosed the case as Type IIIb kidney trauma, which is characterized by deep renal injury in the middle of the kidney. The patient was treated conservatively. Her condition was stable. However, on the 18th day after the traffic accident, hematuria recurred all of a sudden. As anemia progressed, erythrocyte transfusion was done. Radiographs of the arteries in the injured left kidney revealed arteriovenous fistula and psuedoaneurysm. Because of these findings, transcatheter arterial embolism (TAE) was performed using liquid embolic material and a microcoil. After surgery, hematuria ceased and anemia abated. The patient was doing fine for a while. But she suffered from cardiac insufficiency and had to undergo long-term internal treatment. Now, 14 months have elapsed since she met with the accident. There are no recurrence of arteriovenous fistula, no occurrence of renal infarction and no sign of decreased renal functions. This indicates that our TAE operation has been a success. Since there are reports that renal arteriovenous fistula is complicated by cardiovascular diseases, careful watch must be kept on these complications during the long-term management of patients with this type of renal disorder.
