Tratamento não operatório das lesões renais por arma de fogo

Abstract

Objective: To analyze the experience of nonoperative management (NOM) of renal injuries caused by a firearm projectiles (FAP) in the right thoraco-abdominal region in patients with hemodynamic stability and no signs of peritoneal irritation, highlighting the assessment of the safety of this approach. Methods: This was a prospective study with patients sustaining injuries by FAP in the right thoraco-abdominal region and kidney lesions, treated at the João XXIII Hospital (FHEMIG) in Belo Horizonte, from January 2005 to December 2012. Inclusion criteria were: hemodynamic stability, renal morphofunctional study by CT and no signs of peritoneal irritation. Results: A total of 128 patients met the inclusion criteria of the protocol and underwent NOM for right thoraco-abdominal injury by FAP. Of these, 37 (28.9%) had renal injuries. Trauma indexes: RTS 7.8, ISS16, and TRISS 99%. Lesions grade II and grade III were the most frequent. The most commonly associated intra-abdominal injury was of the liver, present in 81.1% of cases. Two patients (5.4%) had failed nonoperative treatment. Conclusion: The nonoperative treatment of such renal lesions, when properly indicated, has a high success rate, low complication rate and increases the chance of renal preservation. It is safe for well-selected patients in trauma centers with adequate infrastructure, experienced professionals and use of a specific protocol.