RETROPERITONEUM

Haematoma

A retroperitoneal haematoma may indicate trauma to a major vessel. If the patient is stable it should not be opened or disturbed. However, to save life, control and repair of a major vessel should be attempted at the district hospital.

Duodenum

Blunt trauma to the upper abdomen can result in retroperitoneal rupture of the duodenum. Air in the retroperitoneum is diagnostic. The retroperitoneum is opened with blunt dissection and the duodenal perforation closed transversely in two layers. This repair should be protected with a nasogastric tube and, after thorough cleansing of the retroperitoneum, a drain should be placed near but not on the duodenal repair.

Pancreas

Confirm an injury to the pancreas by opening the lesser sac through the gastrocolic (greater) omentum. The only safe procedure at the district hospital is to put a drain at the site of injury. The drain should traverse the lesser sac and come out in the flank. Specialized surgery may be necessary. Make arrangements for referral when the patient is stable.

Kidney

Do not expose the kidney unless there is life-threatening bleeding. An expanding or pulsating haematoma is evidence of such bleeding. Stop the bleeding at the site of the tear with stitches. Consider the need for specialized surgery.