Melanie Morote González (Madrid / ES), Laura Cebolla Rojas (Madrid / ES), Maria Galindo Alins (Madrid / ES), Carlos Morales García (Madrid / ES), Carlota Perez Carpio (Madrid / ES), Cristina Rey Valcárcel (Madrid / ES), María Dolores Pérez Díaz (Madrid / ES), Fernando Turégano Fuentes (Madrid / ES)
Abstract text (incl. references and figure legends)
INTRODUCTION
Traumatic retroperitoneal hematomas (TRH) are a frequent entity with a high mortality rate in severe polytraumatized patients. The objective of this study was to evaluate the results of the management of TRH in Zone I in our center, with special focus on its systematic exploration.
MATERIAL & METHODS
Retrospective observational study, with patients included in a prospective severe trauma registry, with TRH in Zone I.
RESULTS
Between 1993 and 2021, 290 patients with TRH were collected, 37 (12.7%) were located in Zone I, 28 of them due to blunt trauma (BTRH) (75.6%), and 9 due to penetrating trauma (PTRH) (24.4 %). The most frequent mechanism of injury in BTRH has been precipitation (35.7%), followed by vehicle collision (25%), run over (21.4%), motorcycle collision (14.2%), and others (3.5%). In PTRH, 66.7% stab wounds and 33.3% gunshot wound are collected.
25 patients (67.5%) underwent surgery, 16 for BTRH and 9 for PTRH. In 6 cases due to hemodynamic instability and in 19 due to CT findings. 17 (68%) died, 14 due to uncontrolled bleeding and 3 due to multifactorial causes. In 3 cases the hematoma was not explored, one of them died due to inadvertent aortic injury, and the other 2 required reintervention, one due to pancreatic injury and the other due to duodenopancreatic and IVC injury.
Of the 12 who did not undergo surgery, 5 (41.6%) died, 3 due to bleeding and 2 due to other causes. The 7 who survived had 2 aortic lesions treated with endoprosthesis, 2 IVC lesions that underwent cavography without contrast leakage, and 3 main aortic branches treated by angioembolization. None of them required reintervention due to bleeding or inadvertent injury.
CONCLUSIONS
In patients in whom TRH is diagnosed by CT, non-operative management is possible in selected patients, but in patients in whom the hematoma is found at laparotomy, exhaustive exploration is necessary to avoid inadvertent injuries that will determine high morbidity and mortality.
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