War injuries of the kidney

Between 2 May 1991 and 2 November 1992, 4425 wounded people were treated at the Clinical Hospital of Osijek, Croatia. A hundred and fifteen (2.6 per cent) had a urogenital injury, 64 (56 per cent) of whom had penetrating kidney injuries. Sixteen (25 per cent) of this 64 were caused by gunshot wounds and 48 (75 per cent) by fragments of mines, mortars or grenades. The majority of the 64 kidney injuries had also associated injuries of some other major organ system, particularly in the abdomen, with only three cases of isolated kidney injury. In 53 patients (82.8 per cent) surgical access was by transabdominal incision, in nine (14 per cent) by extraperitoneal flank incision and in two cases thoracophrenolaparotomy was also performed. Nephrectomy was performed in 16 patients (25 per cent). In 46 (75 per cent) an organ-sparing procedure was done: kidney sutures in 28 (43.8 per cent), kidney resection in five (7.8 per cent) and exploration only in 15 (23.4 per cent). Intrahospital deaths occurred in 11 (18 per cent), seven in the operating theatre. An evaluation of the 6-month follow up for 90 per cent of the surviving patients is presented. It seems that the frequency of renal war injuries was lower than usually reported. Associated abdominal injuries justified surgical access by transabdominal incision. The high mortality rate is explained by a large number of associated injuries and by the proximity of the battlefield with resulting rapid transport of patients (average 52 min), which excluded the possibility of separating out the moribund patients. Long-term follow up confirmed the benefits of the conserving surgical approach.