Peri renal packing (PRP) in post-traumatic haemorrhagic transplanted kidney: A successful extreme rescue attempt

Abstract text (incl. references and figure legends)

Case history: A 51-year-old man arrived in our Trauma Center due to a motorcycle accident. He referred pelvic pain localized in right pelvic fossa and left hip pain. He underwent a right kidney transplantation in the past, due to a chronic renal failure.

Clinical findings: His vital signs were not compromised. Chest x-ray and E-fast resulted negative for parenchymal injuries or pneumothorax, fluid collection around the transplanted kidney apart.

Investigation/Results: He underwent a CT body scan which referred a simple fracture of the left hip bone and an active blush extravasation from the transplanted kidney in right pelvic fossa.

Diagnosis: To prevent an acute renal ischaemia due to an angioembolization of the transplanted kidney, we decided to perform a mechanical haemostasis in the operatory room.

Therapy and Progressions: A right para-median laparotomy has been performed. The transplanted kidney was bleeding from all the parenchyma and haemostasis was achieved thanks to Hemopatch™ and Tisseel™ [fig.1]. From the renal posterior surface bleeding was unstoppable, for this reason a PRP had been performed with 4 swabs in an extreme rescue attempt [fig. 2]. At relaparotomy 24 h later no more blood or active bleeding was detected. The patient has been discharged in 5º post-operative day, no renal failure occurred after surgery and now is in good conditions.

Comments: This successful extreme rescue attempt may open a new scenario in Damage Control Surgery and Uro-Trauma and may prevent post traumatic nephrectomies in those patients who are not fit for angioembolization.

References:

Coccolini F. et al. Kidney and uro-trauma: WSES-AAST guidelines. World J Emerg Surg. 2019 Dec 2;14:54. doi: 10.1186/s13017-019-0274-x. Malhotra MK, Malhotra S. Packing of renal fossa: useful technique for intractable bleeding after open pyelolithotomy surgery. Niger J Surg. 2012 Jan;18(1):37-9. doi: 10.4103/1117-6806.95493.

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