Retroperitoneal hematomas of traumatic origin.

The significance of retroperitoneal hematomas of traumatic origin ranges from inconsequential to fatal. To elucidate factors determining this significance, 203 such instances were analyzed. In 27 patients in whom operation was not required, the diagnosis was established by roentgenologic studies. In 176, the diagnosis was made at celiotomy; in 67, retroperitoneal hematoma had ruptured into the abdomen and all were explored; the retroperitoneal hematoma was not disturbed in 62 because it appeared contained and not expanding. Due to the location around the pancreatoduodenal region or the strong possibility of injury to a major vessel, 39 contained retroperitoneal hematomas and were explored. Of the 39 deaths observed, 31 occurred in the patients admitted with shock. Twelve deaths were attributed to bleeding from the retroperitoneal hematoma. Retroperitoneal hematomas in patients who are in shock, who have peritoneal irritation or positive peritoneal lavage results, should undergo operation. Those retroperitoneal hematomas found to be contained and not expanding should not be opened, unless it is necessary to exclude associated injuries. Patients with retroperitoneal hematomas who are not in a state of shock and who have negative peritoneal lavage results do not need urgent operation, but require observation.