Renal Artery Pseudoaneurysm After Blunt Renal Trauma in a Child: Combinatorial Treatment With Transcatheter Arterial Embolization and Nephrectomy

Abstract

A 13-year-old girl fell from a desk and sustained renal injury. An abdominopelvic computed tomography (CT) scan revealed right renal injury (Japanese Association for the Surgery of Trauma category IIIb). Initially, she was treated by administering an intravenous fluid for resuscitation and managed conservatively. Four days after the trauma, fever occurred and emphysematous changes were observed on the CT scans within the perinephric hematoma in the right kidney. On the basis of a positive result of a urinary culture examination, we suspected that she had a renal parenchymal infection. Eleven days after the trauma, a repeat CT scan revealed a pseudoaneurysm of the main trunk of the right renal artery and right renal parenchyma, with an increase in the size of the lesion compared with that in the previous CT scan. Renal salvage was expected to be difficult because of the pseudoaneurysm of the main trunk of the right renal artery; right nephrectomy was indicated because the kidney infection could not be controlled. A renal artery embolization followed by elective nephrectomy was safely performed to prevent an unexpected rupture of the pseudoaneurysm. The patient’s postoperative course has been uneventful one year after the treatment. When nephrectomy is unavoidable owing to the pseudoaneurysm of the main trunk of the renal artery, preoperative transcatheter arterial embolization may be an optional procedure.