Retroperitoneal Injuries Research Articles

FTP1.11 Retroperitoneal injury is associated with anastomotic leak after colonic injury

Abstract Background The aim of this retrospective observational study was to investigate the association between concomitant retroperitoneal injury and colonic repair failure. Operative repair of perforating colonic injury should ideally maintain bowel continuity. Diversion may be preferable where the repair is likely to fail. To make this decision surgeons must be aware of factors associated with risk of operative failure. Concomitant retroperitoneal injury (RPI) may represent an occult risk factor for post-operative colonic complications. Methods Single-centre study of adult patients admitted to a Level 1 trauma centre between June 2015 and July 2020. Trauma patients with full thickness perforation of either the colon or intraperitoneal rectum were included. We compared clinical outcomes and specifically the incidence of colonic repair leak in patients with or without retroperitoneal injury (RPI). Results Seventy-seven patients met inclusion criteria, of whom 33/77 (43%) had RPI. Mechanism of injury was penetrating in 61/77 (79%) and 49/77 (64%) had isolated abdominal injuries. Patients with RPI had significantly more leaks compared to patients without (9/33 [27%] versus 3/44 [7%], RR 2.0, 95%CI 1.2 to 3.1 p=0.024). Post-operative leak was higher in shocked patients (shock 3/11 [27%] versus not-shocked 9/65 [14%], p=0.37) or those requiring damage control surgery (DCS) (DCS 6/23 [26%] versus non-DCS 6/54 [11%], p=0.17) but neither reached statistical significance. Conclusions RPI is associated with an increased incidence of complications after colonic repair. When selecting operative strategy for perforating colonic injury, surgeons should be aware of increased risk of operative failure in the presence of concomitant RPI.

Hemoperitoneum Due to Trauma in the Superior Pancreatic Artery

Introduction: Abdominal trauma, specifically hemoperitoneum due to retroperitoneal injury, represents a challenge for the surgeon who works in the emergency department. Hemoperitoneum due to rupture of a branch of the dorsal superior pancreatic artery is not frequent; the pancreas is a retroperitoneal organ that, due to its location, is difficult to be affected by trauma. Objective: to contribute to medical knowledge by presenting a case of hemoperitoneum due to a lesion in a branch of the superior pancreatic artery. Material and method: Description of a clinical case and review of the literature. Presentation of the case: a 51-year-old male patient, with a history of chronic alcoholism, who was admitted to the hospital in the surgery department for having had a blunt abdominal trauma of two days of evolution, had intense diffuse abdominal pain, did not expel feces or gas, tachycardic, with an abdominal ultrasound that reported free fluid in the cavity. He was taken to the operating room, finding hemoperitoneum due to a retroperitoneal bleeding lesion, specifically from a bleeding vessel from the superior dorsal pancreatic artery. After surgery, the patient evolved favorably and was discharged. Conclusions: hemoperitoneum due to pancreatic artery injury is not frequent, so sometimes there is a delay in the diagnosis, which threatens a good patient evolution, which justifies the morbidity and mortality in these cases.

Hemoperitoneum due to Trauma in the Superior Pancreatic Artery

Introduction: Abdominal trauma, specifically hemoperitoneum due to retroperitoneal injury, represents a challenge for the surgeon who works in the emergency department. Hemoperitoneum due to rupture of a branch of the dorsal superior pancreatic artery is not frequent; the pancreas is a retroperitoneal organ that, due to its location, is difficult to be affected by trauma. Objective: to contribute to medical knowledge by presenting a case of hemoperitoneum due to a lesion in a branch of the superior pancreatic artery. Material and method: Description of a clinical case and review of the literature. Presentation of the Case: a 51-year-old male patient, with a history of chronic alcoholism, who was admitted to the hospital in the surgery department for having had a blunt abdominal trauma of two days of evolution, had intense diffuse abdominal pain, did not expel feces or gas, tachycardic, with an abdominal ultrasound that reported free fluid in the cavity. He was taken to the operating room, finding hemoperitoneum due to a retroperitoneal bleeding lesion, specifically from a bleeding vessel from the superior dorsal pancreatic artery. After surgery, the patient evolved favorably and was discharged. Conclusions: hemoperitoneum due to pancreatic artery injury is not frequent, so sometimes there is a delay in the diagnosis, which threatens a good patient evolution, which justifies the morbidity and mortality in these cases.

Usefulness and outcome of whole-body computed tomography (pan-scan) in trauma patients: A prospective study

BackgroundSevere trauma can cause multi-organ injuries, and the mortality rate may increase if significant organ injuries are missed. This study was performed to determine whether whole-body computed tomography scan (pan-scan) can detect significant injury and leads to proper management, including alteration the priority of management. MethodsThis prospective study was conducted from January 2019 to March 2021 and involved trauma patients level 1, level 2, and dangerous mechanism of trauma. Additionally, the data of trauma patients who had selective computed tomography scan were retrospectively reviewed to compared the clinical benefits. ResultsTwenty-two patients were enrolled in the prospective study. The pan-scan detected significant organ injury in 86% of the patients. Prioritization of organ injury management changed after performance of the pan-scan in 64% (major change in 64.29% and minor change in 35.71%). Skull base fracture, small bowel injury, retroperitoneal injury, kidney and bladder injury, and occult pneumothorax were the majority of injuries which was not consider before underwent pan-scan (p < 0.05). The door-to-scan time tended to be shorter in the pan-scan group than in the selective scan group without a significant difference [mean (SD), 59.5 (34) and 72.0 (86) min, respectively; p = 0.13]. Pan-scan contribute 100% confidence for trauma surgeon in diagnosis of specific organ injuries in severe injured patients. ConclusionsThe pan-scan facilitates timely detection of significant unexpected organ injuries such as the skull base, occult pneumothorax, small bowel, and retroperitoneum. It also helps to prioritize management and increases the diagnostic confidence of trauma surgeons, leading to better outcomes without delay.

Focused Assessment with Sonography for Trauma

The focused assessment with sonography for trauma (FAST) is a screening ultrasound examination used to identify traumatic free fluid in the pericardium and peritoneum through four key windows: the subxiphoid, the hepatorenal recess, the splenorenal recess, and the suprapubic views. The primary role for the FAST examination is in the bedside evaluation of hemodynamically unstable blunt trauma patients to help direct operative management. The extended FAST (E-FAST) examination involves additional evaluation of the thorax and can reliably identify hemothorax and pneumothorax. The advantages of these modalities include rapid speed, low cost, and a lack of ionizing radiation. The limitations include operator dependence, although validated assessments hold promise in mitigating this issue, and poor sensitivity in identifying retroperitoneal hemorrhages, diaphragmatic injuries, and solid-organ injuries that do not produce significant intraperitoneal hemorrhage. In the future, contrast-enhanced ultrasonography may improve ultrasonographic evaluation of solid-organ injury. Nevertheless, significant concerns remain regarding the wide ranges of sensitivity reported for the FAST examination overall, and ongoing research may better identify its optimal role in evaluating trauma patients. This review contains 10 figures, 7 tables, 8 videos and 58 references Keywords: Blunt trauma; focused assessment with sonography for trauma (FAST); extended FAST (E-FAST); hemothorax; pneumothorax; ultrasonography

Focused Assessment with Sonography for Trauma

The focused assessment with sonography for trauma (FAST) is a screening ultrasound examination used to identify traumatic free fluid in the pericardium and peritoneum through four key windows: the subxiphoid, the hepatorenal recess, the splenorenal recess, and the suprapubic views. The primary role for the FAST examination is in the bedside evaluation of hemodynamically unstable blunt trauma patients to help direct operative management. The extended FAST (E-FAST) examination involves additional evaluation of the thorax and can reliably identify hemothorax and pneumothorax. The advantages of these modalities include rapid speed, low cost, and a lack of ionizing radiation. The limitations include operator dependence, although validated assessments hold promise in mitigating this issue, and poor sensitivity in identifying retroperitoneal hemorrhages, diaphragmatic injuries, and solid-organ injuries that do not produce significant intraperitoneal hemorrhage. In the future, contrast-enhanced ultrasonography may improve ultrasonographic evaluation of solid-organ injury. Nevertheless, significant concerns remain regarding the wide ranges of sensitivity reported for the FAST examination overall, and ongoing research may better identify its optimal role in evaluating trauma patients. This review contains 10 figures, 7 tables, 8 videos and 58 references Keywords: Blunt trauma; focused assessment with sonography for trauma (FAST); extended FAST (E-FAST); hemothorax; pneumothorax; ultrasonography

Focused Assessment with Sonography for Trauma

The focused assessment with sonography for trauma (FAST) is a screening ultrasound examination used to identify traumatic free fluid in the pericardium and peritoneum through four key windows: the subxiphoid, the hepatorenal recess, the splenorenal recess, and the suprapubic views. The primary role for the FAST examination is in the bedside evaluation of hemodynamically unstable blunt trauma patients to help direct operative management. The extended FAST (E-FAST) examination involves additional evaluation of the thorax and can reliably identify hemothorax and pneumothorax. The advantages of these modalities include rapid speed, low cost, and a lack of ionizing radiation. The limitations include operator dependence, although validated assessments hold promise in mitigating this issue, and poor sensitivity in identifying retroperitoneal hemorrhages, diaphragmatic injuries, and solid-organ injuries that do not produce significant intraperitoneal hemorrhage. In the future, contrast-enhanced ultrasonography may improve ultrasonographic evaluation of solid-organ injury. Nevertheless, significant concerns remain regarding the wide ranges of sensitivity reported for the FAST examination overall, and ongoing research may better identify its optimal role in evaluating trauma patients. This review contains 10 figures, 7 tables, 8 videos and 58 references Keywords: Blunt trauma; focused assessment with sonography for trauma (FAST); extended FAST (E-FAST); hemothorax; pneumothorax; ultrasonography

Focused Assessment with Sonography for Trauma

The focused assessment with sonography for trauma (FAST) is a screening ultrasound examination used to identify traumatic free fluid in the pericardium and peritoneum through four key windows: the subxiphoid, the hepatorenal recess, the splenorenal recess, and the suprapubic views. The primary role for the FAST examination is in the bedside evaluation of hemodynamically unstable blunt trauma patients to help direct operative management. The extended FAST (E-FAST) examination involves additional evaluation of the thorax and can reliably identify hemothorax and pneumothorax. The advantages of these modalities include rapid speed, low cost, and a lack of ionizing radiation. The limitations include operator dependence, although validated assessments hold promise in mitigating this issue, and poor sensitivity in identifying retroperitoneal hemorrhages, diaphragmatic injuries, and solid-organ injuries that do not produce significant intraperitoneal hemorrhage. In the future, contrast-enhanced ultrasonography may improve ultrasonographic evaluation of solid-organ injury. Nevertheless, significant concerns remain regarding the wide ranges of sensitivity reported for the FAST examination overall, and ongoing research may better identify its optimal role in evaluating trauma patients. This review contains 10 figures, 7 tables, 8 videos and 58 references Keywords: Blunt trauma; focused assessment with sonography for trauma (FAST); extended FAST (E-FAST); hemothorax; pneumothorax; ultrasonography

Highlighting multidetector computed tomography capabilities in assessing trauma to the retroperitoneal region: a cross-sectional study

ObjectivesThe main objective of this study was to evaluate the different injury types of retroperitoneal trauma regarding their multidetector computed tomography (MDCT) findings.BackgroundTraumatic injuries of the abdomen are one of the most common causes of morbidities and mortalities worldwide. Retroperitoneal traumatic injuries occur in a minority of abdominal trauma; however, they cause higher mortality rates compared with other types of abdominal trauma.Patients and methodsWe conducted a cross-sectional observational diagnostic study on patients admitted for emergent radiological examination following abdominal trauma. History, clinical examination, laboratory investigations, and MDCT were done to detect retroperitoneal injuries and assess their severity.ResultsA total of 21 (70%) patients had renal injuries, two had ureteric injuries, three had pancreatic injuries, two had vascular injuries, two had psoas muscle injuries, and two had a pelvic bone injury. The MDCT showed that 30 patients had at least one retroperitoneal injury. Perinephric hematoma was the most common MDCT finding (42%) in patients with renal injuries. Associated injuries were seen in around one-third of study participants, including pleural effusion and splenic and hepatic injuries. According to the surgical retroperitoneal zones, zone II showed the highest frequency (80%). The final management of our cases were classified as follows: 13 patients were treated conservatively, whereas 19 patients had surgical management.ConclusionMDCT is considered the imaging modality of choice in diagnosing and staging cases with retroperitoneal traumatic injuries. MDCT should be used as a follow-up technique to detect cases missed by the initial CT scan.

Retroperitoneal hematoma: diagnosis and treatment.

Retroperitoneal hematoma is a life-threatening condition where early diagnosis and correct treatment are of utmost importance. Bleeding in the retroperitoneal space has a high mortality rate. The aim of this study was to present current published scientific evidence regarding the incidence, mechanism of injury, diagnostic methods and treatment based on a review of international literature covering the last 40 years. The systematic review of the literature was performed using the SCOPUS and PUBMED databases. Publications in English were included. We have not included publications dealing with this issue in children. Systematic reviews showed an increasing trend toward nonsurgical management of retroperitoneal injuries.

IDIOPATHIC RETROPERITONEAL FIBROSIS: A RARE CAUSE OF ABDOMINAL PAIN AND OBSTRUCTIVE UROPATHY

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Retroperitoneal fibrosis (RPF) is a rare disorder that presents with subtle symptoms. It may be idiopathic or secondary to other causes; with the idiopathic form being either immunoglobulin G4 (IgG4) or non-IgG4 related. The incidence of idiopathic RPF has been reported to be 0.1 per 100,000 person-years with a male-to-female ratio of 1.9:1. Our case aims at highlighting this rare disorder as a cause of abdominal pain in a middle-aged man. CASE PRESENTATION: A 48-year-old man presented with persistent lower abdominal pain, decreased appetite and weight loss for three months. Physical exam was remarkable for mild abdominal tenderness. Laboratory results were remarkable for creatinine 1.6 mg/dL, BUN 56 mg/dL, CRP 35.7 mg/L and ESR 95 mm/hr. CBC, infectious workup, autoimmune panel, serum protein electrophoresis and tumor markers were unremarkable. Serum IgG and immunoglobulin G4 (IgG4) were normal. CT abdomen and pelvis revealed a soft tissue mass surrounding the distal abdominal aorta and inferior mesenteric artery; entrapping the left ureter accounting for left-sided hydroureteronephrosis. The patient underwent left uterolysis and DJ stent placement. Histopathology (H/P) of the mass showed an abundance of fibro-adipose tissue and lympho-plasmacytic infiltration with rare IgG4 positive plasma cells; negative for infection or malignancy. The patient was started on high dose prednisone leading to resolution of clinical symptoms. Serum creatinine level, ESR and CRP also returned to normal. A follow up CT scan showed regression of the mass. DISCUSSION: RPF is a rare fibro-inflammatory disease with poorly understood pathogenesis. Idiopathic RPF accounts for more than 70% of cases, with secondary causes related to retroperitoneal injury, malignancy, infection, drug therapy or genetic factors. Interestingly, a recent study (Zen et al) found a positive correlation between immunoglobin G4 (IgG4) on H/P and idiopathic RPF in 10 cases out of 17 patients. These cases were hallmarked by a unique H/P pattern and elevated serum IgG4 concentration. Our case, however, was the non-IgG4 related type. Patients with IRF most frequently present with abdominal pain, weight loss and features of obstructive uropathy. Elevated inflammatory markers and imaging studies aid in the diagnosis but biopsy is the gold standard. Goals of treatment for RPF is relief of ureteral obstruction and disease regression with glucocorticoids with or without other immunosuppressants. Tamoxifen has been used with success in patients who cannot tolerate glucocorticoids. Biologic therapies such as rituximab and tocilizumab have shown promise in select patients with refractory disease but further research is warranted. CONCLUSIONS: Idiopathic retroperitoneal fibrosis should be kept in the differential diagnosis of a patient presenting with abdominal or flank pain, obstructive uropathy and elevated markers of inflammation. Reference #1: Idiopathic retroperitoneal fibrosis: clinicopathologic features and outcome analysis. Yachoui R, Sehgal R, Carmichael B. Clin Rheumatol. 2016 Feb;35(2):401-7. https://doi.org/10.1007/s10067-015-3022-y. Epub 2015 Jul 25. Reference #2: Idiopathic and secondary forms of retroperitoneal fibrosis: a diagnostic approach. Urban ML, Palmisano A, Nicastro M, Corradi D, Buzio C, Vaglio A. Rev Med Interne. 2015 Jan;36(1):15-21. https://doi.org/10.1016/j.revmed.2014.10.008. Epub 2014 Nov 18. Reference #3: Idiopathic retroperitoneal fibrosis and its overlap with IgG4-related disease. Rossi GM, Rocco R, Accorsi Buttini E, Marvisi C, Vaglio A. Intern Emerg Med. 2017 Apr;12(3):287-299. https://doi.org/10.1007/s11739-016-1599-z. Epub 2017 Jan 9. DISCLOSURES: No relevant relationships by Moses Bachan, source=Web Response No relevant relationships by Muneer Khan, source=Web Response No relevant relationships by Zinobia Khan, source=Web Response No relevant relationships by Mariam Saeed, source=Web Response

Diagnostic Accuracy of Multidetector Computed Tomography in Evaluation of Retroperitoneal Traumatic Injuries and Retroperitoneal Hemorrhage

AbstractBackground: Abdominal trauma represents a main daycare activity in radiology.non surgical treatment has become the standard of care in hemodynamically stable abdominal trauma patients as a result of comprehensive assessment of injury by imaging.MDCT is very sensitive method to detect traumatic injuries and determine the grading of this injuries on which the management will be performed.Aim of Study: To assess diagnostic accuracy of multi-detector CT in evaluation of retroperitoneal traumatic injuries and retroperitoneal hemorrhage.Patients and Methods: Prospective study included 60 patients with abdominal trauma (40 male, 20 females), their age ranged from 7 years to 70 years (mean age 34.8 year). Ultrasonography and MDCT were performed for all patients.Results: 30 patients (50% of the total studied patients) had retroperitoneal injuries, 27 patients of them (90%) were secondary to blunt abdominal trauma and 3 patients (10%) suffered from stab trauma. Fifteen patients had renal injuries; 3 of them associated with adrenal injuries, 2 patients had bowel injuries, 5 patients had pancreatic injuries, 3 patients had vascular injuries and 5 patients had retroperitoneal hematoma related to other injuries; 3 of them had psoas muscle injury and the other 2 patients had urinary bladder rupture.Conclusion: MDCT proved to be accurate and sensitive to evaluate retroperitoneal traumatic injuries and determine the grading and severity of these injuries on which the man-agement will be performed. In addition MDCT proved to be highly sensitive in detection of active hemorrhage which is a life threatening condition.

MON-339 Differential Non-Endocrinological Diagnoses of Retroperitoneal Injury: Report of 2 Cases

Introduction: Retroperitoneal tumors are rare and account for less than 0.1% of all malignant tumors. Although we find more often benign tumors, malignant variants account for 85% of tumors. Once retroperitoneum has a heterogeneous content, there are innumerable non-endocrinological differential diagnoses for these lesions, such as sarcomas (among them the liposarcoma, the leiomyosarcoma and the fibrosarcoma), lymphoma, lipomas, leiomyomas, fibromas and teratomas. Cystic lymphangioma and hibernoma may still be remembered and sought after. Among the endocrinological differential diagnoses, we mainly have: pheochromocytomas, paragangliomas and adrenal carcinomas. The 2 cases described below are examples of non-endocrine differential diagnosis of retroperitoneal lesion. Clinical Case 1: C.L.S.P, 45 years old, female, with low back pain for 1 year, with no weight changing at the analised period. She had no signs or symptoms of hyperandrogenism, hypercortisolism or hypertension, but noticed a palpable mass in the abdomen. Physical examination: palpable mass on the right flank and mesogastrium, well delimited. MRI: Heterogeneous mass, measuring 10x5.6x4 cm, hypervascularized, with cystic foci and lobulated contours, into abdominal cavity, to the right of the midline, determining compression of the below infrarenal vena cava and displacing some intestinal loops above. Laboratory tests: plasma metanephrines, urinary cortisol and cortisol, cortisol after 1mg of dexamethasone, salivary cortisol and ACTH, without changes. DHEAS, 11-deoxycortisol, androstenedione and testosterone, also without changes. Anatomopathological: Peritoneal sarcoma. Clinical Case 2: L.C.F., 42 years old, female, diabetic and hypertensive for about 20 years. She started lumbar pain, on the left, with 6 months of evolution, associated with a loss of 12 kg in the period. She had no signs or symptoms of hyperandrogenism and hypercortisolism. Physical examination with no changes. MRI: Expansive lesion occupying the left adrenal locus, with well defined margins, heterogeneous characteristics, delimiting areas of necrosis / liquefaction, as well as area suggestive of blood content, measuring 15.7x11.1x10.6 cm. Laboratory tests: plasma metanephrines, aldosterone, salivary cortisol, cortisol after 1mg of dexamethasone, urinary cortisol, ACTH, Cortisone, 21-deoxycortisol, DHEAS, Compound S, androstenedione, 17-OHP and estradiol without alterations. Anatomopathological: KIDNEY LEIOMYOSARCOMA. Immunohistochemistry: AE1 / AE3 negative, diffuse AML positive, diffuse caldemon positive, desmin negative and S100 negative. Conclusion: Thus, these differential diagnosis of retroperitoneal lesions should also be suspected by the endocrinologist.

Minimally Invasive Endoscopic-Assisted Lateral Lumbar Interbody Fusion: Technical Report and Preliminary Results.

ObjectiveLateral lumbar interbody fusion (LLIF) is a highly useful lumbar fusion surgical technique for degenerative spinal disease. However, many complications have already been reported. The purpose of this study is to report the concept, surgical technique, and clinical results of the first 70 consecutive cases treated with a safer and minimally invasive endoscopic-assisted LLIF (ELLIF). MethodsThis retrospective study included 70 cases involving 106 segments in which ELLIF was used to treat degenerative spinal disease. We examined the clinical progress, complications and analyzed radiographic images. Regarding the fusion rate, 49 cases involving 72 segments whose follow-up period was more than 7 months were evaluated. ResultsThe mean of preoperative Numerical Rating Scale (NRS) was 7.0 and postoperative NRS was 1.4. Postoperative NRS had a significant correlation with the number of fusion segments (p = 0.028). The mean of preoperative disc space height, foraminal height, sagittal rotation angle, whole lumbar lordosis and sagittal translation distance were 3.3 mm, 14.3 mm, 2.4°, 9.7°, and 3.2 mm, respectively. Postoperative values were 9.4 mm, 17.9 mm, -4.9°, 36.3°, and 0.7 mm. The fusion rate was 79.2%. Complications included, transient psoas muscle weakness 1, sensory disturbance in the thigh 2, retroperitoneal injury 1, postoperative ileus possibly involving a retroperitoneal injury 1, and cage migration 4. ConclusionUsing the ELLIF in the degenerative spinal disease, we obtained good radiological reduction and good clinical results. Our study confirms that ELLIF is safer and provides better results for degenerative spinal disease. However, the issue of cage migration remains to be resolved.

Abdominal Trauma and Complications

The abdomen, including pelvis, is injured in 10 to 15% of significantly injured patients: 80% by blunt and 20% by penetrating mechanisms. Abdominal injuries can be subtle and hence missed. The majority of injuries, if detected early, can be treated, and hence, delay in diagnosis or underappreciation of the severity of intra-abdominal injury is responsible for significant preventable morbidity and even mortality. The initial management is the same as any trauma patient, with the greatest threats to life addressed first. If the patient is in shock and the source is intra-abdominal, urgent laparotomy is indicated along with damage control resuscitation. If the patient remains in shock in the operating room, abbreviated damage control laparotomy should be pursued. In stable patients with penetrating mechanism, if the penetration extends into the peritoneal cavity, operative exploration to identify and address any injury is the safest approach; however, more selective approaches are increasingly being pursued. In stable patients with blunt mechanism, a thorough evaluation, usually including IV contrast-enhanced CT (CECT) is pursued to diagnose, and equally importantly, exclude intra-abdominal injury. High-quality IV CECT has a very high negative predictive value for intra-abdominal injuries. In stable patients, injuries to spleen, liver, and kidney, irrespective of grade, are managed nonoperatively with or without angioembolization. Lower-grade pancreatic injuries are managed nonoperatively or with drainage, whereas higher-grade injuries (involving major ducts) usually require resection. Majority of gastrointestinal hollow viscus injuries are managed with repair, resection with anastomosis or diversion. Delays as short as 8 hours in definitive management of such injuries increase morbidity and mortality. Intra and retro peritoneal genitourinary injuries are repaired and extraperitoneal ones are managed without surgery. Retroperitoneal hematomas are managed based on mechanism, stability, and location. Abdominal trauma is associated with a host of complications that need to be detected early and managed appropriately to prevent delayed morbidity and mortality. This review contains 5 figures, 6 tables, and 60 references. Key Words: abdomen, complications, damage control, diaphragm, hollow viscus, trauma, solid organ, retroperitoneum

Laparoscopic management of retroperitoneal injuries from penetrating abdominal trauma in haemodynamically stable patients.

Background:Laparoscopy is increasingly utilised in the trauma setting. However, its safety and reliability in evaluating and managing retroperitoneal injuries are not known.Aim:The aim of this study was to analyse our experience with laparoscopic management of retroperitoneal injuries due to penetrating abdominal trauma (PAT) and to investigate its feasibility, safety and accuracy in haemodynamically stable patients.Methods:Over a 4-year period, patients approached laparoscopically with retroperitoneal injuries were analysed. Mechanism, location and severity of injuries were recorded. Surgical procedures, conversion rate and reasons for conversion and outcomes were described.Results:Of the 284 patients with PAT, 56 patients had involvement of retroperitoneum. Stab wounds accounted 62.5% of patients. The mean Injury Severity Score was 7.4 (4–20). Among retroperitoneal injuries, the colon (27%) was the most commonly involved hollow viscera followed by duodenum (5%). The kidney (5%) and the pancreas (4%) were the injured solid organs. The conversion rate was 19.6% and was mainly due to active bleeding (73%). Significantly more patients with gunshot wound were converted to laparotomy (38% vs. 9%). Therapeutic laparoscopy was performed in 36% of patients. There were no recorded missed injuries or mortality. Five (9%) patients developed the Clavien-Dindo Grade 3 complications, three were managed with reoperation, one with drainage/debridement and one with endovascular technique.Conclusion:Laparoscopic management of retroperitoneal injuries is safe and feasible in haemodynamically stable patients with PAT. However, a high conversion rate indicates difficulties in managing these injuries. The requirements are the dexterity in laparoscopy and readiness to convert in the event of bleeding.

Abdominal Travmada Mortaliteyi Etkileyen Risk Faktörlerinin Analizi

The present study aims to analyze blunt and penetrating abdominal traumas that were evaluated in our emergency department, the treatment approaches and risk factors of mortality. Six hundred and sixty-four patients were admitted to our emergency department for surgical evaluation for trauma between January 2009 and April 2019. After the exclusion of dead on arrival, patients with missing data and patients without abdominal trauma were excluded from this study. Hundred and thirteen patients with abdominal trauma admitted to our department were evaluated in this study. Demographic, clinical, prognostic and mortality related factors were retrospectively analyzed. The mean age of the patients was 36.08±16.1 years. There were 90 male patients. Eighty patients (70.8%) had blunt abdominal trauma (BAT). Twenty-eight patients (24.7%) had isolated liver and two patients (1.7%) had isolated spleen injury. Combined liver and spleen injury was found in two patients (1.7%). Twenty-two (19.4%) patients had mortality. Causes of mortality were an irreversible hemorrhagic shock (40.9%) and central nervous system (13.6%) injuries. BAT was the main mechanism of injury in patients with mortality (86.4% versus 67%; p<0.001). The frequency of retroperitoneal injury was significantly higher in patients with mortality (50% versus 16.5%, p<0.001). The frequency of extra-abdominal injury in patients with mortality was higher (68.1% versus 49.4%; p=0.047). Mean arterial pressure at admission was found to be significantly lower in patients with mortality (67±26.8 mmHg versus 84.3±17 mmHg; p=0.02). The number of packed erythrocytes transfused in patients with mortality was higher (8.8±8.6 versus 3.3±5.9 units; p=0.047). Mean international normalized ratio (INR) was significantly higher in patients with mortality (4.3±7.1 versus 2.7±4; p=0.016). Mean lactate dehydrogenase level was higher in patients with mortality (1685.7±333.8 versus 675.8±565.3 IU/mL; p<0.001). Mean alanine aminotransferase (ALT) was significantly higher in patients with mortality (430±619 versus 244±448 IU/mL; p<0.001). Mean alkaline phosphatase (ALP) level in patients with mortality was higher (76.9±72.8 versus 67.3±27.8 IU/mL; p=0.003). The presence of retroperitoneal injury and ALT >516 IU/mL were independent risk factors o mortality. We have found certain laboratory variables to increase in patients with mortality. These are related to the severity of trauma. Retroperitoneal injury and increased ALT levels being risk factors of mortality is the most important finding of this study. Our results can guide other centers in the evaluation of trauma patients, and high-risk groups can be identified.

Approach and Management of Traumatic Retroperitoneal Injuries

Traumatic retroperitoneal injuries constitute a challenge for trauma surgeons. They usually occur in the context of a trauma patient with multiple associated injuries, in whom invasive procedures have an important role in the diagnosis of these injuries. The retroperitoneum is the anatomical region with the highest mortality rates, therefore early diagnosis and treatment of these lesions acquire special relevance. The aim of this study is to present current published scientific evidence regarding incidence, mechanism of injury, diagnostic methods and treatment through a review of the international literature from the last 70 years. In conclusion, this systematic review showed an increasing trend toward non-surgical management of retroperitoneal injuries.

Abordaje y manejo de las lesiones retroperitoneales traumáticas

Traumatic retroperitoneal injuries constitute a challenge for trauma surgeons. They usually occur in the context of a trauma patient with multiple associated injuries, in whom invasive procedures have an important role in the diagnosis of these injuries. The retroperitoneum is the anatomical region with the highest mortality rates, therefore early diagnosis and treatment of these lesions acquire special relevance. The aim of this study is to present current published scientific evidence regarding incidence, mechanism of injury, diagnostic methods and treatment through a review of the international literature from the last 70 years. In conclusion, this systematic review showed an increasing trend towards non-surgical management of retroperitoneal injuries.

CT imaging in assessing the severity of retroperitoneal injuries in blunt abdominal trauma

Background: Trauma is a leading cause of death in developing countries due to vehicular and railway accidents, of which abdominal trauma due to blunt injuries constitutes 13% mortality and 45% morbidity. The purpose of this study is to assess and diagnose the severity of those retroperitoneal injuries other than the common causes of abdominal trauma with multidetector computed tomography (MDCT) scanning with intravenous contrast being the gold standard diagnostic modality even in unstable patients.Methods: A total of 204 patients of these 147 patients were males (72%) and 57 were females (28%) were included of all age groups, who had sustained abdominal trauma due to vehicular, railways accidents and also due to trivial trauma and history of fall from heights.Results: Of the 204 patients included in our study, 110 patients (55%) had the maximum trauma affection to the kidneys, in which 48% constitutes grade I injury, which shows the high sensitivity of MDCT detecting early injuries. Nearly 12% patients had adrenal injuries, 24% had pancreatic injuries, although a small percentage also had delayed manifestation of pseudocyst formation in stable patients. Duodenal and colonic injuries constitute rest of 5% and 4% of the patients. All these patients had good correlation with the morphological MDCT grading of injuries and clinical correlation.Conclusions: MDCT is the imaging procedure of choice for early detection or ruling out the presence of retroperitoneal injuries in trauma patients, especially now with the newer faster MDCT, scanning can be performed more quickly, minimizing patient movement, respiratory motion and vascular pulsation.