The management of retroperitoneal haematoma discovered at laparotomy for trauma

AimTo review our local experience with presentation and management of retroperitoneal haematomas (RPH) discovered at laparotomy and factors affecting outcome.MethodsPatients with retroperitoneal haematomas (RPHs) were identified from a prospective database. Data collected included demographics, clinical presentation, zones and organs involved, management and outcome.ResultsOf a total of 488 patients with abdominal trauma, 145 (30%) with RPH were identified 136 of whom were male (M:F = 15:1). Mean age was 28.8 (SD 10.6) years and median delay before surgery was 7 h. The injury mechanisms were firearms (109), stabs (24), and blunt trauma (12). Twenty-four patients (17%) presented with shock. There were 58 Zone I, 69 Zone II, and 38 Zone III haematomas. The median injury severity score (ISS) was 9. Fifty-two patients (36%) developed complications and 26 (18%) patients died. Sixty-four (44%) patients required ICU with median ICU stay of 3 days. All Zone I injuries were explored; Zones II and III were explored selectively. The mortality for Zones I, II, III and IV was 14%, 4%, 29% and 35%, respectively. Mortality was highest for blunt trauma and lowest for stabs (p = 0.146). Twelve of 24 patients with shock died (50%) compared to 14 of 121 (12%) without shock (p < 0.0001). Eighteen of 64 patients with <6-h delay before surgery died (28%) compared to 8 of 81 (10%) with >6-h delay (p < 0.017). Mortality increased with increasing ISS. Median hospital stay was 8 days.ConclusionRPH accounted for 30% of abdominal trauma. Injury mechanism, presence of shock, delay before surgery and ISS showed a significant association with mortality.