Overview of the diagnosis and initial management of traumatic retroperitoneal injury
- Samuel P Mandell, MD, MPH, FACS
Samuel P Mandell, MD, MPH, FACS
- Assistant Professor of Surgery, Department of Surgery
- Harborview Medical Center
- University of Washington
Traumatic injury to retroperitoneal structures often accompanies abdominal trauma. The retroperitoneum represents a potential anatomic space that is immediately posterior to the abdominal cavity. It contains organs that are entirely within the retroperitoneum, as well as some organs that traverse from and back into the abdominal cavity. Hemodynamically unstable patients with retroperitoneal hematoma represent an intraoperative diagnostic challenge. A high clinical suspicion is needed to recognize and appropriately manage retroperitoneal injuries.
An overview of the injury mechanisms, recognition, and management of traumatic injury to the retroperitoneum is provided. The initial evaluations of blunt and penetrating injury to the abdomen are reviewed separately.
Operative management and the decision for retroperitoneal exploration require a thorough knowledge of the mechanism of injury and of the organs contained within and adjacent to each other in the retroperitoneum (figure 1).
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- RETROPERITONEAL ZONES
- TRAUMA EVALUATION
- Injury mechanism
- Associated injuries
- CLINICAL EVALUATION
- Injury grading
- APPROACH TO MANAGEMENT
- When to explore retroperitoneal hematoma
- - Penetrating injury
- - Blunt injury
- Nonoperative management
- EXPLORATION OF RETROPERITONEAL HEMATOMA
- Damage control laparotomy
- Surgical approach by zone
- - Zone 1
- - Zone 2
- - Zone 3
- Left medial visceral rotation
- Right medial visceral rotation
- SPECIFIC INJURY MANAGEMENT
- Major vascular injury
- - Major venous injury
- - Major arterial injury
- Duodenum and pancreas
- Kidney/adrenal gland
- Collecting system
- Retroperitoneal colon
- SUMMARY AND RECOMMENDATIONS