Renal salvage following traumatic herniation of the kidney in a dog

Authors: Thomson C, Porter SA, Mitchell RA, Tipler AE
Publication: Australian Veterinary Practitioner, Volume 50, Issue 1, pp 32-40, Mar 2020
Publisher: Australian Veterinary Association

Animal type: Dog
Subject Terms: Animal remedies/veterinary medicines, Clinical examination, Kidney/renal disease, Trauma/injuries
Article class: Clinical Report

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Abstract:

A 6-year-old female entire Whippet was treated by her primary care veterinarian shortly after being attacked by a larger dog. She had sustained significant trauma around the midabdominal region, with severe diffuse ventral abdominal bruising and multiple full-thickness skin lacerations over the dorsal flank. After 3 days of supportive treatment in hospital, she was referred for additional assessment. Abdominal radiography and ultrasonography revealed a herniated left kidney. A ventral midline exploratory laparotomy showed that the kidney had herniated into a subdermal 'pocket'. It was diffusely black in colour with coalescing regions of capsular haemorrhage. The cranial pole had an exposed collecting system, because a portion had avulsed from the main body of the kidney. The latter remnant was resected, the kidney was returned to the abdomen and omentum was used to cover the cranial pole of the kidney.

Postoperatively, an indwelling urinary catheter was used to ease retrograde pressure on the collecting system of the kidney. The dog inadvertently removed the catheter on two occasions (postoperative days 5 and 7), with subsequent urine leakage from the kidney into the peritoneal cavity each time. The dog was catheterised for a third time, with the catheter intentionally removed on day 15, without adverse effects.

According to the grading system of the American Association for the Surgery of Trauma, the dog's renal injury was classified as grade 4 (on a scale of 1-5), indicating that nephrectomy was not required, and that, if she had not sustained renal herniation, the case could have been managed non-surgically.

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