What Is a Retroperitoneal Hematoma?

Retroperitoneal hematoma is a common complication of abdominal and waist injuries and can be caused by direct or indirect violence. The most common causes are pelvic and spinal fractures; followed by ruptured retroperitoneal organs (kidney, bladder, duodenum, pancreas, etc.) and damage to large blood vessels and soft tissues. Because of its combination of severe compound injuries and hemorrhagic shock, the mortality rate can reach 35% to 42%.

Basic Information

English name

retroperitoneal hematoma

Visiting department

surgical

Common locations

Abdominal cavity

Common causes

Fracture of pelvis and spine; rupture of retroperitoneal organs (kidney, bladder, duodenum, pancreas, etc.) and damage to large blood vessels and soft tissues

Common symptoms

Abdominal pain, bloating, low back pain, hemorrhagic shock, abdominal muscle tension, rebound pain

Causes of retroperitoneal hematoma

Can be caused by direct or indirect violence. The most common causes are pelvic and spinal fractures; followed by ruptured retroperitoneal organs (kidney, bladder, duodenum, pancreas, etc.) and damage to large blood vessels and soft tissues. Because it often combined with severe compound injuries, hemorrhagic shock and so on.

Clinical manifestations of retroperitoneal hematoma

Retroperitoneal hematoma lacks characteristic clinical manifestations, and varies greatly with the degree of bleeding and the extent of the hematoma. Abdominal pain is the most common symptom. Some patients have abdominal distension, low back pain, and hemorrhagic shock. Large hematoma or accompanied by infiltration of the peritoneal cavity may have abdominal muscle tension and rebound pain, bowel sounds weakened or disappeared.

Most of the retroperitoneal hematomas caused by abdominal great vessel damage are caused by penetrating injuries. Progressive bloating and shock suggest that this diagnosis should be performed immediately with active laparotomy to control bleeding.

Retroperitoneal hematoma examination

1. Ordinary X-ray examination or double contrast angiography

Can reveal some of the lesions that can cause retroperitoneal hemorrhage, such as fractures, abdominal aortic aneurysms, urinary or gastrointestinal diseases, unclear contour of the psoas major muscle, and interruption of the edge.

2.B ultrasound

Hematomas and abdominal aortic aneurysms can be found, but it is often difficult to distinguish hematomas from abscesses and other fluid accumulations such as urine.

3.CT inspection

It can clearly show the relationship between hemorrhagic hematoma and other tissues, and the increase in attenuation value when enhanced scanning is evidence of active bleeding.

4. Angiography and isotope scanning

Can indicate the location of the bleeding.

5.B-mode ultrasound or CT guided puncture and aspiration

To clear the diagnosis.

6. Laboratory inspection

The initial white blood cell count is slightly higher or normal, and the red blood cells and hemoglobin can be reduced. In the later period, the white blood cell count is significantly increased, and the neutrophil is increased. Serum amylase and urine amylase were increased during pancreatic injury. Hematuria proteinuria can occur in renal contusion and laceration.

Diagnosis of retroperitoneal hematoma

For abdominal, spinal and pelvic trauma with abdominal pain, bloating and low back pain, hemorrhagic shock, abdominal muscle tension and rebound pain, weakened or disappeared bowel sounds, the possibility of retroperitoneal hematoma should be considered. X-ray examination can reveal signs of spinal or pelvic fractures, disappearance of psoas muscle shadow, and abnormal renal shadows, suggesting the possibility of retroperitoneal hematoma. B-mode ultrasound and CT examinations often provide reliable diagnostic evidence.

Diagnostic abdominal puncture can often be distinguished from intra-abdominal hemorrhage, but the puncture should not be too deep, so as not to penetrate into the retroperitoneal hematoma, which led to the misunderstanding of intra-abdominal hemorrhage and laparotomy.

Treatment of retroperitoneal hematoma

1. Penetrating abdominal injury with retroperitoneal hematoma

After treating abdominal organ injuries, hematoma should be further explored. Upper abdominal retroperitoneal hematoma is often a characteristic of retroperitoneal duodenal or pancreatic injury. A Kocher incision should be made, and the duodenum and pancreatic head should be turned to the left. The duodenal segments 1 and 2 are explored and the Treitz ligament is cut , Further exploration of duodenal segments 3, 4 and the whole pancreas. Non-surgical treatment of stable perirenal hematoma without shock and large amounts of hematuria can be given. If necessary, the diagnosis is confirmed by intravenous pyelography, and the diagnosis cannot be confirmed or the bleeding is not stopped. Renal angiography is an accurate method for diagnosing renal arteries and kidney damage, and it can also be used for embolization to control bleeding. Those who are not effective in non-surgical treatment should be surgically explored.

2. Macrovascular injury retroperitoneal hematoma

You should make adequate preparations before detecting the hematoma, including blood transfusion, vascular occlusion, and repair anastomosis. For good exposure, the lateral peritoneum can be cut along the avascular zone on the left side of the paracolonic sulcus, and the descending colon, spleen, stomach, tail of the pancreatic body and the left kidney are turned up to the right. The combined thoracoabdominal incision can well expose the lower end of the descending aorta and the aorta above the kidney. After quickly detecting the damage of blood vessels, the blood flow near the distal end of the fracture was blocked and repaired. Penetrating injuries often run through the anterior and posterior walls of the blood vessel. If the blood vessel cannot be turned over, the posterior wall can be repaired through the anterior wall crack, and then the anterior wall crack.