Conservative treatment of blunt traumatic right renal venous pseudoaneurysm: A case report

Abstract

Introduction: Venous pseudoaneurysm is uncommon in blunt trauma patients, and renal venous pseudoaneurysm is especially rare, even though renal trauma occurs in approximately 8-10 % of abdominal trauma cases. There is controversy regarding the modality of treatment between surgery, conservative care, and radiologic intervention to manage renal venous pseudoaneurysms. We would like to share our experience treating blunt trauma patients having renal venous pseudoaneurysm with conservative care.

Presentation of case: A 53-year-old female patient was transferred to our trauma center following a pedestrian accident. Contrast-enhanced abdominal computed tomography (CT) showed right renal injury (grade II) with partial infarction (approximately 30-40 %) and peri-renal hematoma confined to Gerota's fascia without extravasation, a 3 cm sized right renal venous pseudoaneurysm, and a liver laceration (grade III) with a small amount of perihepatic hemoperitoneum. Since her vital signs were stable, with no decrease in the hemoglobin level in the short-term follow-up laboratory test, we decided to treat the patient conservatively in the trauma intensive care unit without angioembolization or surgery. The patient was discharged on the 14th day after OR/IF surgery for a right distal tibiofibular fracture. On a CT scan performed 1 month after discharge, a peri-renal hematoma was no longer observed, and the renal venous pseudoaneurysm had nearly improved.

Discussion: Patients with renal arterial injury with unstable vital signs require surgery or angioembolization. Even if vital signs are stable, arterial pseudoaneurysms are more likely to rupture; therefore, surgery or angioembolization is required. In contrast, venous pseudoaneurysms can be managed conservatively compared to intervention or surgery in vitally stable patients because they have a lower possibility of rupture due to relatively low pressure.

Conclusion: Renal venous pseudoaneurysms are very rare. Surgery, conservative care, and radiologic intervention should be considered depending on the patient's condition. Because venous blood flow is slower than arterial blood flow, renal venous pseudoaneurysm can be treated with conservative care if there are no injuries requiring further management and if the patient's vital signs are stable.

Keywords: Blunt trauma; Conservative treatment; Pseudoaneurysm; Renal vein.