Delayed Recognition of AAST Grade IV Blunt Renal Trauma Successfully Managed with Renal Arterial Embolization: A Case Report

I Gede Suwedagatha¹, I Ketut Sudiasa¹, I Wayan Periadijaya¹, I Komang Weka¹, Cokorda Bagus Nurparma Putra², Pande Ayu Kirana Dewi^2*, I Putu Ramanda Suadnyana²

Abstract

Background: High-grade blunt renal trauma may present without hemodynamic instability, gross hematuria, or positive focused abdominal ultrasonography, potentially delaying definitive diagnosis. In stable patients, contrast-enhanced computed tomography and endovascular intervention have become central to contemporary nephron-sparing management. Case Presentation: A 25-year-old man sustained blunt multisystem trauma after a bicycle accident. Initial evaluation demonstrated hemodynamic stability, a Glasgow Coma Scale score of 15, negative Focused Assessment with Sonography for Trauma (FAST), and no gross hematuria. He was initially discharged after observation but returned with persistent abdominal pain. Repeat FAST remained negative. Contrast-enhanced abdominal computed tomography subsequently demonstrated an American Association for the Surgery of Trauma Grade IV right renal injury with suspected active bleeding, associated Grade II splenic injury, and hemoperitoneum. Despite the radiological severity of injury, the patient remained hemodynamically stable without peritonitis or another indication for emergency laparotomy. Serial hemoglobin measurements showed a decline from 14.9 to 12.6 g/dL. A kidney-preserving endovascular strategy was therefore selected, and renal arterial coil embolization was performed. Following embolization, the patient remained clinically stable, with controlled pain, preserved urine output of approximately 2.08 mL/kg/h, no gross hematuria, and no immediate requirement for repeat embolization, renal exploration, or nephrectomy. Conclusion: This case highlights that negative FAST examinations and absence of gross hematuria do not exclude high-grade renal trauma. Persistent post-traumatic symptoms should prompt definitive cross-sectional imaging. In appropriately selected hemodynamically stable patients with high-grade renal injury and active hemorrhagic features, renal arterial embolization may provide effective hemorrhage control while supporting an organ-preserving management strategy.

Keywords

blunt renal trauma; renal artery embolization; angioembolization; AAST grade IV; nephron-sparing management

Cite This Article

Suwedagatha, I. G., Sudiasa, I. K., Periadijaya, I. W., Weka, I. K., Putra, C. B. N., Dewi, P. A. K., Suadnyana, I. P. R. (2026). Delayed Recognition of AAST Grade IV Blunt Renal Trauma Successfully Managed with Renal Arterial Embolization: A Case Report. International Journal of Scientific Advances (IJSCIA), Volume 7| Issue 5: Sep – Oct 2026, Pages 562-572 URL: https://www.ijscia.com/wp-content/uploads/2026/10/Volume7-Issue5-Sep-Oct-No.1077-562-572.pdf

Volume 7 | Issue 5: Sep – Oct 2026