Shattered kidney with active bleed

Case contribution: Dr Radhiana Hassan


  • A 21 years old man, history of cyanotic heart disease and operation done 5 years ago. Post op NYHA I.
  • Involved in MVA ( motorcycle versus a car)
  • Complaint of left lumbar pain and hematuria
  • Bedside ultrasound shows left renal injury
  • CT for further assessment
CT scan of abdomen in axial planes


CT scan findings:

  • Multiple deep lacerations of left renal cortex extending to collecting system centrally
  • There is associated large perinephric hematoma (white arrows)
  • It causes displacement of splenic artery and veins, pancreas and left renal vein anteriorly
  • Left renal perfusion and excretion is preserved
  • There is contrast extravasation suggestive of active hemorrhage (yellow arrows)
  • Flat IVC (red arrows) suggestive of  hypovolemia state
  • Small splenic intraparenchymal lacerations seen
  • Fractures of lower ribs on the left side

Intraoperative findings:

  • Lacerations at lateral aspect of left kidney, extending to hilum,
  • Active hemorrhage with extensive hemoperitoneum.  Blood loss 2200ml.
  • Spleen normal. Splenic cleft seen at lateral surface
  • Left nephrectomy performed.

Diagnosis: Shattered left kidney with active hemorrhage

Progress of patient:

  • Active CPR done during surgery for 3 minutes
  • A total of 8pint PC, I cycle DIVC regime was transfused.
  • Patient was discharged well 2 weeks later
  • Discharged, Hb=11.9 and review after 2 weeks show patient was well


  • Renal injuries count for about 10% of abdominal trauma
  • Computed tomography (CT) is the modality of choice in the evaluation of blunt renal injury
  • CT can provide precise delineation of a renal laceration, help determine the presence and location of a renal hematoma
  • It can demonstrate injury with or without active arterial extravasation,
  • It can also show the presence of urinary extravasation or of devascularized segments of renal parenchyma.
  • Most important, CT can help differentiate trivial injuries from those requiring intervention.
  • Shattered kidney is considered Grade V in AAST grading scale
Author: radhianahassan