A young man with a broken kidney due to a traffic accident, bleeding a lot, was promptly blocked by doctors to stop the bleeding, avoiding the risk of death.
Patient Ngo Xuan Thao (HCMC), was taken to Tam Anh General Hospital in Ho Chi Minh City for emergency on September 29 with pale skin, stiff abdomen, pale pink urine.
According to BS.CKI Duong Dinh Hoan, Interventional Imaging Unit, Center for Diagnostic Imaging and Interventional Radiology, the patient had contusion, bleeding in the right lower half of the kidney, with retroperitoneal hematoma, with pictures. bleeding with about 1,000 ml of blood, grade 4 kidney injury according to the American Association for Trauma Surgery (AAST). Of the 5 levels of kidney injury, grade 4 is when a large rupture penetrates the calyx, renal pelvis, causing urine leakage and damage to small blood vessels.
“If not timely intervention, a lot of bleeding will cause low blood pressure and death,” said Dr. Duong Dinh Hoan.
Emergency physicians, interventional radiologists, and nephrologists were convened for an urgent consultation and decided that prompt endovascular intervention was needed to prevent excessive bleeding.
Doctor CK2 Thi Van Ginger, Head of the Interventional Imaging Unit, Center for Diagnostic Imaging and Interventional Radiology, said that when he first looked at the abdominal CT image, the team thought it was not difficult. However, when performing the intervention, the doctors encountered difficulties due to the narrowing of the blood vessels because of a lot of blood loss, moreover, the bleeding site came from a very small artery branch of the renal artery. If the catheter is placed at the base of the renal artery, the site of bleeding will not be visible.
The doctors had to select deep into each branch to check for the bleeding site and then proceed to occlude the blood vessel to stop the bleeding. In this case, the site of active bleeding spreads to the back of the peritoneum, causing retroperitoneal hematoma, along with spreading to the renal pelvis, causing hematuria, so if the hematoma is not stopped, the hematoma will progress faster and the condition will become worse. Blood in the urine will get worse and worse.
The time for embolization intervention with other cases is on average 20-30 minutes, but in patients with small blood vessels like this, it takes more time for doctors to intervene (45 minutes) to block the bleeding site. .
According to BS.CKI Duong Dinh Hoan, thanks to timely intervention and hemostasis, the patient avoided having to undergo nephrectomy to stop bleeding. The morning after surgery, the patient showed no signs of further blood loss and was walking normally. Thao is now awake, pink skin, less abdominal pain, clear yellow urine. Three days after the intervention, the patient can be discharged from the hospital.
Mr. Thao said that that day, while traveling on the road, he was suddenly hit by a motorbike rider behind, the handlebars hit the right flank. He only felt pain in one side of his ribs, subjectively thinking he was not injured. A few hours later, the pain became so intense that he could not stand it, so his family called an ambulance to take him to the hospital.
According to Dr. Ginger, the most common kidney injury is caused by traffic accidents, most of which are closed kidney injuries that can be treated with conservative medical treatment or stop bleeding. With severe cases like the above, patients need to be treated promptly at hospitals with full expertise and equipment.
* The character name was changed.