Selective Nonoperative Management of Kidney Gunshot Injuries

Nonoperative management (NOM) of kidney gunshot injuries as an alternative to surgical exploration is rarely reported. The aim of this study was to assess the feasibility and safety of selective NOM of such injuries. A 4-year prospective study was conducted that included all patients admitted to a Level I trauma center with kidney gunshot injuries. Patients with abdominal gunshot wounds and hematuria with no indications for immediate laparotomy (peritonitis, hemodynamic instability, head or spinal cord injury) underwent intravenous contrast abdominal computed tomography. Patients with confirmed kidney injuries were observed with serial clinical examinations. Outcome parameters included the need for delayed laparotomy, complications, length of hospital stay, and survival. During the study period, 33 patients with kidney gunshot injuries were selected for NOM without laparotomy. The mean Injury Severity Score was 10.5 (range 4-25). Simple kidney injuries (grades I, II) occurred in 15 (45.5%) patients and complex kidney injuries (grades III, IV) in 18 (54.5%) patients. Associated injuries included 14 of the liver (42.4%), 4 (12.1%) of the spleen, and 6 (18.2%) each of the diaphragm, lung (contusion), and hemothorax. Three patients required delayed laparotomy: two for nonrenal indications, and one patient had a delayed nephrectomy for a grade IV injury. The overall successful NOM rate was 90.9%. The mean hospital stay was 5.9 days (range 2-23 days). There were no kidney-related complications and no mortality. Selective NOM of patients with kidney gunshot injuries is a feasible, safe, effective alternative to routine exploration.