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Retroperitoneal hematoma after blunt trauma.
W A Goins1, A Rodriguez, J Lewis
1Department of Surgery, Maryland Institute for Emergency Medical Services Systems, Baltimore 21201-1595.
Surgery, Gynecology & Obstetrics
|April 1, 1992
Summary
Retroperitoneal hematoma (RPH) from blunt trauma is rare but serious. Management requires aggressive resuscitation and a multidisciplinary approach, especially for zone III injuries, to reduce high morbidity and mortality.
Area of Science:
- Trauma Surgery
- Surgical Outcomes
- Emergency Medicine
Background:
- Retroperitoneal hematoma (RPH) is a significant complication of blunt trauma.
- Blunt abdominal trauma admissions include 13% with RPH.
- Motor vehicle accidents are the leading cause of RPH.
Purpose of the Study:
- To analyze the characteristics, management, and outcomes of patients with retroperitoneal hematoma (RPH) due to blunt trauma.
- To identify injury patterns and optimal treatment strategies for different RPH zones.
Main Methods:
- Retrospective review of 233 consecutive patients with blunt trauma-induced RPH.
- Analysis of injury mechanisms, RPH location, diagnostic methods, surgical exploration, and outcomes.
- Categorization of RPH based on anatomical zones (I-IV).
Main Results:
- 55% of patients had pelvic fractures; laparotomy was the primary diagnostic tool (73%).
- RPH distribution: Zone I (14%), Zone II (37%), Zone III (46%), Zone IV (3%).
- Major vascular injuries (21%) in Zone I, kidney injuries (27%) in Zone II, and pancreatic/duodenal injuries in right Zone II RPH require careful evaluation. Zone III RPH with pelvic fractures rarely needs exploration, favoring external fixators and embolization.
Conclusions:
- High overall morbidity (59%) and mortality (39%) necessitate aggressive resuscitation and hemorrhage control.
- A multidisciplinary approach is crucial for managing blunt trauma-induced RPH.
- Specific management strategies should be tailored to RPH location and associated injuries.