Penetrating injuries to the perinephric region require exploration and repair. It is crucial that the initial mobilization be done efficiently with minimal blood loss, and that no additional damage be done to the kidney during mobilization. The capsule is easily stripped from the renal parenchyma. Take care to preserve the capsule, as it is the part that best holds the suture.

Mobilize overlying colon by incising the avascular line and allowing the colon and its mesentery to come to the midline. Carefully inspect the colon and mesentery for injuries as you do this. This should expose the underlying perinephric hematoma.

Decide whether or not to perform preliminary vascular control by isolating the renal artery and renal vein in the midline,
away from the hematoma. Some surgeons routinely obtain preliminary control and others do it selectively. Preliminary vascular control allows the perinephric hematoma to be explored with minimal additional blood loss; however, it may require significant additional time (and associated continued blood loss into the hematoma). Many surgeons use preliminary vascular control selectively, employing it when the nature of the injury or the appearance of the hematoma suggests that major arterial bleeding will be encountered on exploring the injury.

To obtain preliminary vascular control, isolate the renal artery and vein outside the hematoma in the midline. See Chapters 108e and 109 for a discussion of the relevant anatomy.