Penetrating lateral retroperitoneal haematoma - do you go in??

[Hardcastle, Tim, Dr <tch at sun.ac.za>]

Karim

My approach is to have pre-op checked for haematuria. If not present then we would not explore the kidney but would mobilise and review the retroperitoneal part of the colon and peak at the ureter, since we would not have done pre-op IVP. If we had haematuria a pre-op IVP (not a 1-shot!) would be performed and if normal despite microhaematuria we would leave the ureter too, since most likely it is a non-bleeding kidney injury, which can safely be conservatively watched - I have not yet had a missed ureteric injury using this philosophy.

Realise my "context": 20000 per year trauma-only service with a 60% penetrating trauma census.

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302



-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Karim Brohi
Sent: Friday, November 10, 2006 8:17 AM
To: trauma-list at trauma.org
Subject: Penetrating lateral retroperitoneal haematoma - do you go in??


A quick poll to the group:

Penetrating injury to the abdomen, you're doing a lapararotomy for whatever
reason.  When you get in there's a large lateral retroperitoneal haematoma.
The patient is h(a)emodynamically normal. The haematoma is big but not
pulsatile, not expanding.

You'd leave it if it was blunt trauma.  Standard practice for penetrating
would say explore.

Would YOU go in?

Karim 

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