Retroperitoneal Injury

Retroperitoneal Injury

• Outline– General approach.– Anatomical boundaries.– Retroperitoneal Zones.– Cases.– Surgical Exposure.

Retroperitoneal Injury

• Approach.

• Mechanism of injury.– Blunt abdominal injury.

» Mostly non-operative management.

– Penetrating abdominal injury.» Mostly requires exploration.

Retroperitoneal Injury

• Anatomical boundaries.

– The Anterior Abdomen.– The Flank.– The Thoracoabdominal area.– The Box.

Retroperitoneal Injury

• Anatomical boundaries.

Zone 1

Zone 2

Zone 3

Retroperitoneal Injury

Retroperitoneal Injury

• Case 1:– 29 year old male, High speed

MVC.– Ejected from the car.– Unconscious, Sat 88, BP:90/50,

GCS 6, no external source of bleeding.

– Intubated, bilateral chest tubes inserted, pelvis wrapped.

– Sat 94, HR:110, BP:90/50.– FAST positive.

Retroperitoneal Injury

• Case 1:– Trauma laparotomy.– Splenectomy.– Zone 1 hematoma.– Zone 2 hematoma.– Zone 3 hematoma.

Retroperitoneal Injury

• Case 2:– 42 year old male, abdominal

stab.– Alert, Sat:99, BP:145/65,

HR:89.– Has a 2 cm wound in the

anterior abdominal wall.

Retroperitoneal Injury

• Case 2:– Trauma laparotomy.– Small bowel injury.– Zone 1 hematoma.

• Stable.• Unstable.

Retroperitoneal Injury

• Case 2:– Trauma laparotomy.– Small bowel injury.– Zone 2 hematoma.

• Stable.• Unstable.

Retroperitoneal Injury

• Case 2:– Trauma laparotomy.– Small bowel injury.– Zone 3 hematoma.

• Stable.• Unstable.

Retroperitoneal Injury

• Left medial visceral rotation.

Retroperitoneal Injury

• Mattox maneuver

Retroperitoneal Injury

• Right medial visceral rotation.

Retroperitoneal Injury

• Cattell-Braasch manoeuvre

Discussion & Questions