Patients with penetrating renal injuries often have associated injuries to other intra-abdominal organs that require laparotomy. All Zone 2 (perinephric) penetrating wounds should be explored following principles of vascular injury repair in the retroperitoneum after ensuring methods for proximal and distal vascular control. Generally, in the case of blunt injury, a hematoma confined to the retroperitoneum can be left undisturbed; however, persistent bleeding, expanding hematoma, or medial hematomas suggest a hilar, aortic, or caval injury and warrant direct evaluation (Figure 2 & 3).6