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.
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.
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.
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.