What are the retroperitoneal zones of injury?

The retroperitoneum is divided into three main zones of injury: zone I is the central/midline retroperitoneum, zone II encompasses the perinephric space, and zone III comprises the pelvic retroperitoneum. Treatment of retroperitoneal hematomas varies depending on the anatomical location and mechanism of injury.

Where does retroperitoneal bleeding occur?

Retroperitoneal bleeding is a serious illness that occurs when blood enters into space in the back of the belly. This usually occurs after a traumatic injury and may require surgery to fix.

What is traumatic retroperitoneal hematoma?

Retroperitoneal hematomas are the result of blood loss due to the injury of parenchymal tissue or vascular structures within the retroperitoneal cavity. Traumatic Retroperitoneal Hematoma. In the setting of traumatic retroperitoneal hematoma, the mechanism of injury can be broken down into blunt or penetrating.

What is the Mattox maneuver?

Definition. Mattox Maneuver, also known as a left medial visceral rotation, is a surgical step to explore and handle Zone 1 and 2 retroperitoneal injuries (aorta, left iliac and pelvic vessels). It starts with incising the parietal peritoneum at the white line of Toldt from the sigmoid colon to the splenic flexure.

What causes retroperitoneal hematoma?

There are several well-recognized causes of retroperitoneal hematoma, including ruptured aortic aneurysm, traumatic vascular injury, retroperitoneal neoplasms, and coagulopathy. [2] In addition, there are documented reports implicating low molecular weight heparin as a potential cause.

What can cause a retroperitoneal hematoma?

Is retroperitoneal bleed painful?

Spontaneous retroperitoneal hemorrhage is a rare clinical entity; signs and symptoms include pain, hematuria, and shock.

Is a retroperitoneal hematoma serious?

Traumatic retroperitoneal hematoma is a common, life-threatening complication of abdominal or pelvic injuries, early diagnosis and urgent surgical intervention are of utmost importance.

How do you treat retroperitoneal hematoma?

Treatment 1,2,5,6

1. Conservative management. Fluid resuscitation. Blood transfusion. Anticoagulant reversal.
2. Surgery and/or Interventional Radiology Consult. Surgical decompression. Percutaneous drainage. Embolization.

What is Cattell Braasch maneuver?

A right medial visceral rotation, the Cattell-Braasch maneuver, is used to expose the en- tire inframesocolic retroperitoneal organs, including the inferior vena cava (IVC), the right renal pedicle, the right iliac vessels, the duodenum, and the head of the pancreas.

How do you expose the aorta?

Injuries to the diaphragmatic aorta can be exposed via laparotomy and entry into the lesser sac, left anterolateral thoracotomy, or via left medial visceral rotation with division of the left crus in the two o’clock position.

What is Zone 1 of retroperitoneal hematoma?

Zone 1 (central) extends from the esophageal hiatus to the sacr … Traumatic retroperitoneal hematoma (RPH) may arise from injury to bony structures, major blood vessels, and intestinal or retroperitoneal viscera. To categorize the management of RPH, the retroperitoneum may be divided into three zones.

What is the prevalence of retroperitoneal injuries?

Retroperitoneal injuries are known to occur in a significant minority of abdominal trauma cases (12% of hemodynamically stable patients evaluated at one center [,1]). Physical examination and laboratory tests can be unreliable in detecting abdominal injuries, particularly retroperitoneal injuries (,2).

What are potential sources of traumatic retroperitoneal hemorrhage?

Identify potential sources of traumatic retroperitoneal hemorrhage. Blunt abdominal and pelvic trauma can cause significant and sometimes life-threatening injuries to retroperitoneal structures.

Can ultrasonography detect retroperitoneal trauma?

Bedside tests such as diagnostic peritoneal lavage and focused ultrasonography for the assessment of trauma can yield negative findings or fail to help detect signs of retroperitoneal injury, even in the presence of significant retroperitoneal injury, since these methods principally help assess the peritoneal space (, 3,, 4 ).