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 is the most common location for a retroperitoneal hematoma to occur?
Zone III encompasses the pelvic retroperitoneum and is the most common location of retroperitoneal hemorrhage, frequently in association with pelvic fractures (,43,,44,,48).
When do you explore retroperitoneal hematoma?
Mandatory exploration should be performed in cases of retroperitoneal hematomas resulting from penetrating injury, but the selection of treatment mode in blunt injury depends on the anatomical position of hematoma, visceral injury and the hemodynamic status of the patients.
How do you assess for retroperitoneal bleeding?
ASSESSMENT
- loin and/ or abdominal pain.
- often no cutaneous signs, but may have Cullen sign (umbilical ecchymosis) and Grey Turner sign (flank ecchymosis)
- +/- palpable swelling.
- haematuria.
- haemodynamic instability and shock.
- evidence of abdominal compartment syndrome (e.g. intra-abdominal hypertension, renal failure)
What type of arterial puncture is associated with an increased risk of retroperitoneal bleeding?
A higher femoral arterial puncture site is an important procedure-related risk factor for RPH [2,6,17]. It is defined as a puncture above the inguinal ligament or above the middle 1/3 of the femoral head on fluoroscopy or above the IEA [2,6,17].
Is a retroperitoneal hematoma serious?
Retroperitoneal (RP) hematoma or hemorrhage is a rare but potentially life-threatening diagnosis. The presentation and symptoms can be subtle.
What are the symptoms of retroperitoneal bleed?
Retroperitoneal bleeding is an accumulation of blood in the retroperitoneal space. Signs and symptoms may include abdominal or upper leg pain, hematuria, and shock. It can be caused by major trauma or by non-traumatic mechanisms.
How do you evaluate for retroperitoneal bleeding?
CT angiography (CTA) is usually performed to detect the site of active retroperitoneal bleeding in cases of known or clinically suspected acute bleeding. Like CT, CTA provides the exact location of hematoma.
What is 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 degree is an arterial puncture performed?
With the needle bevel up and the syringe at a 30- to 60-degree angle to the radial or brachial artery, puncture the skin slowly ( Figs. 81-4 and 81-5 ). For a femoral artery puncture, a 60- to 90-degree angle is used ( Fig.
What are the sites for arterial puncture?
The radial artery is the preferred site for arterial puncture and cannulation. One reason is the comparative ease of identifying the anatomical location of this artery. A second reason is the collateral nature of the arterial blood supply to the hand provided by the radial and ulnar arteries.
How is a retroperitoneal hematoma treated?
Treatment 1,2,5,6
- Conservative management. Fluid resuscitation. Blood transfusion. Anticoagulant reversal.
- Surgery and/or Interventional Radiology Consult. Surgical decompression. Percutaneous drainage. Embolization.
Can you survive a retroperitoneal bleed?
Retroperitoneal bleeding is a deadly condition with anywhere from 6% to 22% of those affected. [3][4] Rapid diagnosis and treatment amongst a team of seasoned acute care personnel is key to patient survival.
What is the Cattell Braasch maneuver?
A right medial visceral rotation, the Cattell-Braasch maneuver, is used to expose the entire 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 do a Kocher maneuver?
The maneuver starts by incising the periduodenal peritoneum about 1 cm from the lateral duodenal margin. By gently pulling the bowel mediad the assistant puts traction on it. Lift the parietal peritoneum at the level of the mid-duodenum and incise it with scissors.