retroperitoneal hematoma
Introduction
Introduction to retroperitoneal hematoma Retroperitoneal hematoma is a common complication of abdominal and lumbar injuries, accounting for about 10 to 40%, which can be caused by direct or indirect violence. The most common cause is pelvic and spinal fractures, accounting for about 2/3; followed by rupture of the retroperitoneal organs (kidney, bladder, duodenum, and pancreas) and major vascular and soft tissue injuries, as they often involve severe combined injuries. Hemorrhagic shock, etc., the mortality rate can reach 35 to 42%. basic knowledge The proportion of illness: 0.035% Susceptible people: no specific population Mode of infection: non-infectious Complications: peritonitis shock
Cause
Cause of retroperitoneal hematoma
Cause
Retroperitoneal hemorrhage is common in complex abdominal injuries, accounting for 2/3 of retroperitoneal hemorrhage. mainly includes:
1. blunt trauma: retroperitoneal space with rupture of liver, spleen, kidney, adrenal gland, pancreaticoduodenal and blood vessels; pelvic fracture with rectal, bladder and ureteral injury; abdominal blunt contusion, pelvic fracture Directly or indirectly damage the retroperitoneal blood vessels and their branches.
2. Penetrating trauma: penetrating injury of bullets or shrapnel; sharp knife or sharp stab wound; puncture wound of osteophyte after fracture. Retroperitoneal hemorrhage can also be seen in the pathological destruction of retroperitoneal organs, including: a. hemorrhagic necrotizing pancreatitis; b. hemorrhagic diseases, such as hemophilia, leukemia, hypersplenism, etc. caused by various reasons Low coagulation can cause peritoneal hemorrhage; c. anticoagulant therapy due to hypocoagulability; d. retroperitoneal surgery; e. Other: there are retroperitoneal tumors, hemangioma, nodular multiple arteries Inflammation and spontaneous retroperitoneal vascular rupture (abdominal stroke).
pathology
Because of the loose tissue behind the retroperitoneum, the bleeding episodes are mostly sudden, and the hematoma rapidly infiltrates into a large hematoma. Systemic reactions can have a drop in blood pressure, even shock. The retroperitoneal tissue is compressed, and the hematoma can be diffused along the posterior wall of the abdomen and between the mesentery, and can also be worn through the abdominal cavity. If the bleeding occurs slowly or stops by itself, a wrapped or localized hematoma can be formed. Finally, the center is liquefied or fibrotic, and the small hematoma can be absorbed.
Prevention
Retroperitoneal hematoma prevention
Avoid injury factors, when the hematoma ruptures should be treated in time to prevent the occurrence of hemorrhagic shock.
Complication
Retroperitoneal hematoma complications Complications peritonitis shock
1, secondary peritonitis.
2, hemorrhagic shock.
Symptom
Symptoms of retroperitoneal hematoma Common symptoms In the formation of hemorrhage in the wide ligament of the bowel, abdominal pain, internal hemorrhage, shock, abdominal distension, abdominal muscle tension, reflex low back pain
Retroperitoneal hematoma is also often accompanied by peritoneal irritation (intestinal paralysis, tenderness and rebound tenderness, muscle tension, etc.), which is a simple peritoneum that determines whether there is difficulty in abdominal organ injury, without large blood vessels or important organ injuries. After hematoma, the peritoneal irritation sign appears later and mildly. After anti-shock treatment, it can be effective. Diagnostic abdominal puncture can often be differentiated from intra-abdominal hemorrhage, but the puncture should not be too deep, so as not to penetrate into the retroperitoneal hematoma, so that the intra-abdominal hemorrhage is mistaken. In the case of laparotomy, if the diagnosis is not certain, strict observation is absolutely necessary.
There is a lack of characteristic clinical manifestations of retroperitoneal hematoma, and the extent of hematoma varies greatly with the degree of hemorrhage. Abdominal pain is the most common symptom. Some patients have abdominal distension and low back pain, and 1/3 of patients with hemorrhagic shock have a large hematoma. Those who have infiltrated the peritoneal cavity may have abdominal muscle tension and rebound tenderness, and the bowel sounds weaken or disappear.
More than 90% of retroperitoneal hematoma caused by abdominal aorta (abdominal aorta and inferior vena cava) is caused by penetrating injury. Due to rapid massive bleeding, most patients die at the scene, and the death rate after delivery to the hospital is also reached. 70%, progressive abdominal distension and shock suggestive of this diagnosis, should be active anti-shock, immediately laparotomy to control bleeding.
Examine
Examination of retroperitoneal hematoma
1. Ordinary X-ray examination or double contrast angiography can reveal some lesions that can cause post-peritoneal hemorrhage, such as fractures, abdominal aortic aneurysm, urinary tract or gastrointestinal disease, unclear outline of the psoas muscle and partial interruption of the margin.
2. B-mode ultrasound can detect hematoma and abdominal aortic aneurysm, but the identification of hematoma and abscess and other fluid accumulation (such as urine) often have certain difficulties.
3. CT examination can clearly show the relationship between hemorrhagic hematoma and other tissues, and the attenuation value increases when the scan is enhanced, which is evidence of active bleeding.
4. Angiography and isotope scans can indicate the location of the bleeding.
5. B-mode ultrasound or CT-guided puncture aspiration to confirm the diagnosis.
6. Laboratory tests: initial white blood cells are slightly higher or normal, red blood cells and hemoglobin can be reduced, white blood cells are significantly increased, and neutrophils are increased. Both serum amylase and urinary amylase increased during pancreatic injury. Hematuria proteinuria can occur during renal contusion.
Diagnosis
Diagnosis and differentiation of retroperitoneal hematoma
X-ray examination may be considered for abdominal, spinal and pelvic trauma with abdominal pain, bloating and low back pain, hemorrhagic shock, abdominal muscle tension and rebound tenderness, weakened or disappeared bowel sounds. From the spine or pelvic fracture, the disappearance of the psoas muscle shadow and the abnormal renal shadow, suggesting the possibility of retroperitoneal hematoma, B-mode ultrasound and CT examination can often provide a reliable basis for diagnosis.
