Case report: Conservative management of a blunt trauma to a horseshoe kidney

With trauma representing the leading cause of death in children, and renal injuries representing a large proportion of that trauma, understanding the appropriate management of renal injuries is vital to preventing pediatric morbidity and mortality. Cases involving aberrant anatomy are even more crucial to understand as there is less data on appropriate management. Here, a case is presented of a 7-year-old male presenting after a horse kick to the abdomen resulting in traumatic disruption of a previously unknown horseshoe kidney and the subsequent conservative management. The patient presented with abdominal pain, leukocytosis, and elevated liver function enzymes. An abdominal and pelvic Computed Tomography (CT) demonstrated a horseshoe kidney with a grade IV laceration to the isthmus and left lower pole of the kidney resulting in fracture/disruption of previously fused horseshoe kidneys. Additionally, there was a large retroperitoneal hematoma and hemoperitoneum. The patient was successfully managed with observation, and hemodynamic monitoring and has had resolution of hematoma and preserved kidney function through 8 months of follow-up. In conclusion, this is an example of how a patient with complicated renal anatomy can be managed conservatively to model for potential future cases.