The World Society of Emergency Surgery (WSES) has reported guidance for management of renal trauma.
Patient selection: blunt or penetrating injury to the kidney
Indications for laparotomy:
(1) hemodynamic instability (WSES IV)
(2) transient response to resuscitation
(3) non-self-limiting bleeding from main renal vessels
(4) other indications for laparotomy seen on contrast-enhanced CT scan
(5) ineffective endovascular management
(6) ineffective angioembolization
(7) hemodynamic instability during non-operative management
Indications for angioembolization:
(1) blush seen on contrast-enhanced CT scan
Non-operative management requires expertise and ready access to diagnostic and therapeutic modalities. It is often appropriate for WSES I, II or III grade injuries, including those after effective angioembolization.
