ABSTRACT
Severe renal vascular injuries require immediate operative exploration to prevent life-threatening hemorrhage. Damage control nephrectomy is required in the critically ill patient with multiple associated injuries and a high mortality risk.10,12,13 Although uncommon, isolated venous injuries can be successfully repaired but should only be pursued in a hemodynamically stable patient. Main renal artery injuries that require extensive reconstruction should only be performed in patients with a solitary kidney or bilateral severe renal injuries as renal salvage is poor.13,14
Figure 10.1 shows the surgical approach to renal exploration. A midline transabdominal incision from the xyphoid to the pubic symphysis provides maximum exposure for complete abdominal exploration to detect associated organ injury. Immediate bleeding should be controlled with laparotomy packs and surgical repair.
