The advantages of nonsurgical or surgical management of renal injuries are important when the renal trauma is found during a laparotomy for intra-abdominal injury. Blunt external trauma caused 85.5% of the renal injuries found during laparotomy in 194 patients.
A large dose or infusion intravenous pyelogram on a modified operating table has allowed immediate evaluation of the renal Injury during a laparotomy.
When the degree of renal injury was more severe, renal tissue and function were saved by early surgical management. In this group, lowered morbidity and a sharp reduction in delayed renal operations followed the introduction of immediate surgical management. The nephrectomy rate was 11%, which compares favorably with that of nonsurgical management.
Clamping of the renal vessels prior to opening Gerota fascia prevented reactivation of hemorrhage and allowed for a deliberate operation with conservation of undamaged renal tissue.