The 99 patients of traumatic retroperitoneal hematoma among consecutive 368 trauam who were admitted to the depatment of surgery, Korea University hospital for a period of 5 years from January 1987 to December 1991 were subjected to this study
for
the
purpose of evaluating of efficacy of peritoneal lavage on decision of exploration of retroperitoneal hematoma.
Diagnostic peritoneal lavage were carried out in 63 patients out of 99 retroperitoneal hematoma as part of the initial evaluation of their condition. The 33 patient were excluded for this lavage because of patient's condition such as shock and
abdominal
distension.
There were postivie lavage in 47 patients. Of these 47 patients 16934%) had found to have false-postitive lavage on exploration of abdomen.
There were 87 blunt abdominal trauma and 12 stab abdominal wound. Of these 87 blunt abdominal trauma patients, 71 patients were carried out abdominal exploration and all 12 stab wound patients had abdominal exploration.
There were 8(9.6%) Zone I, 29(24.9%) Zone II, and 46(55.4%) Zone III retroperitoneal hematomas according to Kudsk's classfication in 83 patients who had abdominal exploration.
Of those 71 blunt trauma patients, all 8 zone I, 18 out of 21 patients zone II and 6 out of 42 patients zone II patients had explored retroperitoneal hematoma on abdominal exploration.
3 out of 21 zone II and 14 out of 42 zone III patients had unnecessary operation because there were no intra-abdominal injuries and they did not need explored retroperitoneum.
Therefore diagnostic peritoneal lavage in patients, suspected to have retroperitoenal hematoma, is not reliable parameter to decide for exploration of intraabdominal injuries. To reduce unnecessary operation in patients suspected to have
retroperitoenal
hematoma abdominal sonogram, computed tomography, MRI and excretory urography should be added as a another armamentarium in diagnosis of intraabdominal organ injuries, especially in pelvic fracture patients with stable condition.
In conclusion, we recommedn sonogram, computed tomography, MRI and excretory urography with physical examination on top of peritioneal lavage in suspected to have Zone II and Zone III retropeitoneal hematoma.
|