Time Is Kidney: A Case Study and Literature Review of Bilateral Renal Compartment Syndrome After Blunt Trauma, a Rare Complication.

Abstract

<b>Background:</b> Acute compartment syndrome (ACS), a condition characterized by elevated pressure within an enclosed compartment, leads to ischemia and organ failure, and is hence a surgical emergency. Renal compartment syndrome (RCS) is a disease in which there is an increase in the pressure within the native kidney's compartment due to peri-renal or subcapsular fluid collection, causing acute kidney injury. To our knowledge, the diagnosis of bilateral traumatic renal compartment syndrome (BTRCS) due to trauma has not been previously described in the literature. <b>Case Presentation:</b> The patient is a 20-year-old female presenting as a case of blunt trauma due to a severe motor vehicle collision. Initially, investigations showed multiple injuries, including a femur fracture that was managed accordingly. Postoperatively, she remained stable with no signs of complications. However, after 10 days, she began complaining of abdominal pain. Further workup revealed an acute drop in hemoglobin, elevated serum creatinine, and bilateral perinephric hematomas. BTRCS was diagnosed and was surgically managed by open laparotomy and bilateral capsulotomy, with the return of robust urine production. The patient recovered successfully and was consequently discharged. <b>Conclusions:</b> This paper reports a case of renal compartment syndrome that was diagnosed and treated appropriately. Doppler ultrasound and CT scan, along with renal function tests, are the investigations of choice. Although there can be a role for conservative management, open surgical decompression remains the definitive treatment in patients with progressive renal dysfunction. To our knowledge, this represents the first reported case applying the term "bilateral traumatic renal compartment syndrome (BTRCS)" involving native kidneys following blunt trauma, successfully treated with bilateral surgical decompression and rapid physiological recovery.