Retroperitoneal Hematoma types and management the lect.ppt
- 1. Management of Traumatic Retroperitoneal Hematoma HAMED RASHAD Professor of Surgery -Egypt
- 2. Retroperitoneal SIP A DUCK S=SUPRARENAL GL I=IVC + BRANCHES P=PANCREAS HEAD A=AORTA D=DUODENUM U=URETERS C=CISTERNA CHYLI K=KIDNEYS
- 3. Retroperitoneal hematoma Zone 1 (Central) – Explore regardless of mechanism. Zone 2 (Flank) – Explore penetrating trauma. – Observe blunt trauma (nonexpanding, nonpulsatile, no urologic indications) Zone 3 (Pelvic) – Explore penetrating. – Observe blunt.
- 4. 1- pelvic haematoma associated with pelvic fracture should Not be disturbed. 2- perinephric haematoma (Stable-Not expanding) are best left undisturbed. Retroperitoneal haematomas : 7/31/2024 4
- 5. 3-Central haematomas that may involve Injury to : -Major Vessels. -pancreas. -Duodenum. NotedMinor Leave. major-or-expanding explore After Control of all injuries in the peritoneal cavity. 7/31/2024 5
- 6. CT : Left retroperitoneal haematoma
- 7. CT : Left retroperitoneal haematoma
- 8. Lower down cut – Rectus sheath haematoma (big arrow)
- 9. Rt retroperitoneal haematoma with active bleeding (curved arrow)
- 10. CT Rt Retroperioneal haematoma A-Retropertoneal haematoma & Aortic Aneurysm B- Leaking AO (curved arrow)
- 11. Leaking aortic aneurysm : endovascular stent graft in place (black arrow)
- 12. Retroperitoneal Haematoma Gain access: Division of gastrohepatic lig., left medial visceral rotation (Mattox maneuver), right visceral rotation (Catell maneuver) with Kocher maneuver direct repair, rarely grafting
- 13. Retroperitoneal Haematoma Z I RPH (supramesocolic) – Mattox m. Z II RPH (flank) – unless pulsatile, expanding or ruptured do not explore Z III RPH (pelvic) – as above, packing or angiographic embolisation if required
- 14. Mattox maneuver
- 15. Cattel maneuver
- 17. Operation ? based on mechanism of injury + hemodynamic status + extent of associated injuries Opened Midline, lateral paraduodenal, lateral pericolonic not associated with pelvic, and portal hematomas are after proximal vascular control has been obtained, if appropriate. Not opened Selected retroperitoneal hematomas in the lateral perirenal and pelvic areas Retrohepatic hematomas without obvious active hemorrhage
- 18. Penetrating trauma most still opened Exceptions : isolated lateral perirenal hematomas that have been carefully staged by CT and some lateral pericolonic hematomas Blunt trauma without obvious active hemorrhage not opened
- 19. Traumatic retroperitoneal hematoma (RPH) Zone 1 (central) : esophageal hiatus to the sacral promontory Zone 2 (lateral) : lateral diaphragm to the iliac crest Zone 3 (pelvic) : retroperitoneal space of the pelvic bowel Surgical exploration persistent hemodynamic instability, mechanism of injury, location Urgent surgery upper central area (Zone 1) + penetrating trauma + injury to the great vessels Evaluation : CT and/or angiography
- 20. Thanks for your attention!!
- 21. Bilateral Pubic Ramus Fractures and Sacroiliac Joint Disruption What should this injury make you worry about?
- 22. THANK YOU