Grade V renal injury and Grade IV liver injury

Case contribution: Dr Radhiana Hassan


  • A 19 years old man
  • Motorcyclist, skidded motorbike
  • Complaint of abdominal pain
  • On examination, fully conscious, tachycardia. BP normal.
CT scan abdomen in axial plane soft tissue window post contrast

CT scan findings:

  • Multiple liver lacerations involving segment VI, VII and VIII (red arrows)
  • Lacerations of right kidney (yellow arrows) that shattered the kidney
  • Massive perinephric hematoma
  • Moderate hemoperitoneum
  • No other injury

Intra-operative findings:

  • Shattered right kidney at hilum
  • Liver laceration involving Segment VI and VIII.
  • Gall bladder intact.
  • Gross hemoperitoneum. Blood loss 3L.
  • Contusion at duodenum and spleen.
  • No bowel perforation.

Diagnosis: Grade V right renal injury and Grade IV liver injury.

Progress of patient:

  • Right nephrectomy done.
  • Liver packing done.
  • Repeat CT scan after one month shows complication of biliary leakage.
  • Stent was inserted.


  • Grade IV liver injury is defined as parenchymal laceration causing disruption 0f 25-75% of a hepatic lobe or 1-3 Couinaud segment within a single lobe.
  • Grade IV liver injury also include ruptured intraparenchymal hematoma with active bleeding.
  • Grade V renal injury is laceration that completely shatter the kidney or injury to renal hilum with devascularization of the kidney.
Author: radhianahassan