上段のEarly phase CT図３，図４と図８，下段のdelayed phase CT図１４，図１５と図１９で左腎に裂創があり（▲），腎周囲腔に少量の血腫がある（↑：日本外傷学会分類，腎損傷 H１）．Early phaseの図５〜図７と，delayed phaseの図１６〜図１８の△は挫創（contusion）と思われる．Delayed phaseで腎盂と尿管が造影されているが周囲に尿の漏出を認めない．表在性損傷II型と分類され，ほとんどの例で保存的治療が成功する．図１〜図４の脾臓の白矢印は損傷ではない．図１３〜図１５のdelayed phaseでは脾臓がムラなく造影されている．このように脾臓はearly phase CTで，または造影剤を急速に注入したとき不均一に造影されることがあるので注意を要する．脾臓は動脈系から静脈系への交通がリンパ流を交えて，多岐に亘るネットワークで構成しているためと言われる．

文献考察：小児の腎外傷
１）374例中腎温存率は99％．
J Urol. 2004 Aug;172(2):687-90; discussion 690.
Pediatric renal injuries: management guidelines from a 25-year experience.
Buckley JC, McAninch JW.

PURPOSE: We defined the mechanism and cause of pediatric renal trauma, and developed guidelines for management based on the outcome analysis of operative vs nonoperative management. MATERIALS AND METHODS: We retrospectively reviewed 374 pediatric renal injuries at San Francisco General Hospital, comparing operative vs nonoperative management based on clinical presentation, type of renal injury, hemodynamic stability, associated injuries and the results of radiographic imaging. RESULTS: Blunt trauma accounted for 89% of pediatric renal trauma with a renal exploration rate of less than 2%. Penetrating trauma represented the remaining 11% with a renal exploration rate of 76%. Of grade IV renal injuries 41% were successfully managed nonoperatively based on computerized tomography and staging in hemodynamically stable children. Our overall renal salvage rate was greater than 99%. CONCLUSIONS: Pediatric renal trauma is often minor and observation poses no significant danger to the child. In serious pediatric renal injuries early detection and staging based on clinical presentation and computerized tomography are critical for determining operative vs nonoperative management. Regardless of the type of management the standard of care is renal preservation (less than 1% nephrectomy rate in this series).PMID: 15247762

２）101例の鈍的腎外傷．保存的治療の成功率は94.7％，腎温存率は98.9％．
J Trauma. 2004 Sep;57(3):474-8; discussion 478.
Blunt renal injuries in children can be managed nonoperatively: outcome in a consecutive series of patients.
Nance ML, Lutz N, Carr MC, Canning DA, Stafford PW.

BACKGROUND: Nonoperative management of radiographically defined solid organ injuries has proven highly successful in children with blunt splenic and hepatic injuries. The role of nonoperative management protocols is less well defined for blunt renal injuries. The purpose of this study was to review the management and outcome of a consecutive series of children with blunt renal injury. METHODS: The trauma registry from a Level I pediatric trauma center was reviewed to identify all children (age
３）小児腎外傷で尿路系の先天異常が発見されるのは12.6％．
J Pediatr Surg. 2002 May;37(5):779-82.
Blunt renal trauma-blessing in disguise?
Chopra P, St-Vil D, Yazbeck S.

PURPOSE: The purpose of this study was to quantify pathologic lesions of the kidney found incidentally during the workup of a blunt renal trauma. METHODS: A retrospective review of the medical records of 103 patients ages 0 to 18 years with blunt renal injuries admitted to a level 1 pediatric trauma center between January 1, 1991 and December 31, 1999 was performed. All patients underwent ultrasonography and Doppler of their renal vessels. Additional investigations with computed tomography (CT) scan, cystography, or nuclear medicine functional studies were performed as indicated. RESULTS: Coexisting urogenital lesions were identified in 13 of 103 (12.6%) patients reviewed, and 7 (54%) required surgical treatment. The majority of the patients (9 of 13, 69%) suffered minimal trauma. All patients presented with gross hematuria as their main symptom. Stenosis of the uretero-pelvic junction was the most frequent diagnosis (n = 7): 3 patients required uretero-pyeloplasty, and 3 required nephrectomy. Two heterogeneous renal masses were discovered in which the diagnosis of a malignant process could not be eliminated; elective resection and open biopsy were performed. The diagnoses of multicystic kidney and solitary cyst with complex hematoma, respectively, were confirmed on pathology. Grade III ureterovesical reflux with pyelonephritis (n = 1), polycystic kidney (n = 1), extrarenal pelvis without obstruction (n = 1), and horseshoe kidney (n = 1) were the other lesions discovered. CONCLUSIONS: Pathologic lesions of the urinary tract are uncommon; however, they may complicate an otherwise negligible renal trauma. The diagnostic and therapeutic approach to blunt renal trauma must be modified in these cases. A high index of suspicion must be maintained when a patient presents with gross hematuria with a minimal force blunt abdominal trauma. PMID: 11987100