Management of retroperitoneal haematoma following penetrating trauma

Abstract

Experience with the management of 106 consecutive patients found to have a retroperitoneal haematoma (RH) at laparotomy for penetrating trauma over a 2-year period is reviewed. Three types of retroperitoneal haematoma are recognized: Type I (central), Type II (flank) and Type III (pelvic). Type I RH was present in 22 patients as a result of injuries to the inferior vena cava (9), the aorta (5), the pancreas and duodenum (5), the portal vein (2), and to both aorta and inferior vena cava (1). Fourteen patients died (63.8 per cent) representing 70 per cent of all deaths in the series. Type II RH was seen in 73 patients. Thirty-two were stable and the perinephric fascia was not opened with no morbidity or mortality. Forty-one were explored: 15 on pre-operative evidence of renal injury which was confirmed at laparotomy. In the remaining 26 a stable haematoma was explored and no significant lesion found. It is considered that in 45 of 73 Type II RH (61.0 per cent) exploration was unnecessary. Five patients died (6.8 per cent). Type III RH was found in 11 patients and was due to iliac vessel injuries. Two patients died. In conclusion Type I and III RH should be routinely explored. Stable Type II RH discovered at laparotomy should be explored selectively based on pre-operative clinical and radiological assessment of renal injury.

Massive retroperitoneal haematoma because of renal cyst rupture, report of a case

“…It is a virtual space where up to 3000 ml of blood can accumulate (Braunstein et al, 1964). Casuistry indicates that when there is a retroperitoneal hematoma, bleeding in 75% of cases is from penetrating trauma and 25% from non-penetrating trauma (Steichen et al, 1966;Costa & Robbs, 1985).…”

Delayed Presentation of Ilio-Iliac Arteriovenous Fistula Following Laparoscopic Cholecystectomy Treated with Percutaneous Graft-Covered Stent Placement

“…Nevertheless, the estimated mortality of an isolated retroperitoneal major vessel injury is 20%. 5,6 The consultation of a vascular surgeon is essential to prevent secondary damage to the vessel and to perform proper vessel restoration without ligation.…”