Conservative treatment of acute traumatic left renal vein oc
Isolated acute traumatic renal vein occlusion is rare. As both kidneys have limited capsular and peripelvic vein collaterals, acute renal vein occlusion could lead to renal infarction. However, the left renal vein has potential collateral pathways through the gonadal vein.

A 56-year-old woman was transferred to our trauma center after a pedestrian accident. Computed Tomography (CT) with contrast enhancement showed that no delineation of the left renal vein with adjacent retroperitoneal hematoma around renal vessels, but left renal venous flow was being drained through a left gonadal vein, therefore, the left kidney was not congested. Her serum creatinine concentration was normal. Author elected to treat her left renal vein occlusion conservatively because of the collateral pathway into the gonadal vein.

Collateral pathway of the left renal venous drainage may be well known to urologists or vascular surgeons but may be unfamiliar to trauma surgeons. Therefore, the trauma surgeon’s attempts for revascularization of thrombosed left renal vein may lead to massive bleeding or nephrectomy.

In conclusion, acute left renal vein occlusion close to the inferior vena cava can result in temporary venous hypertension and congestion followed by the complete or nearly complete return of function as collateral veins enlarge. If the gonadal vein is patent, left renal vein occlusion could be treated conservatively.