Polytrauma and retroperitoneal hematoma: 616-001:617.553:616.36-005.1

Abstract

Introduction. Treatment policy for severe combined abdominal trauma remains the most complex and unresolved question of modern surgery. At the same time, the results of treatment and outcome of trauma depend on feasibility of one or another intervention.

Materials and methods. The treatment experience of 811 victims with severe combined abdominal trauma is presented, the most common causes of which were road traffic accidents — 583 (71,9%) and catatrauma — 228 (28,1%). The severity of injury was assessed by indexes of damage severity and severity of state. Physical, laboratory and instrumental methods for diagnostics of retroperitoneal hematomas are presented.

Results. Intraoperatively retroperitoneal hematoma was identified and checked in 129 (16%) of patients. During the revision of retroperitoneal hematoma we found pancreatic damage in 47 (36,4%) of patients, ruptures of retroperitoneal segments of duodenum — in 6 (4,6%) persons and kidney ruptures — in 31 (24%). The causes of retroperitoneal hematomas were vena cava ruptures — in 5 (3,9%) cases and abdominal aorta ruptures — in 4 (3,1%) cases. In 34 (15%) patients clinically significant retroperitoneal and intrapelvic hematomas were caused by fractures of pelvic bones, accompanied by hemorrhagic shock III–IV class.

Conclusion. Tactical approaches of surgical treatment are presented depending on hematomas causes and localization.

References

1. Kolesnikov V. V., Kotelnikov G. P., Leskin A. S., Onishchenko N. S. Tactics of surgical treatment of victims with severe combined abdominal trauma [Taktika hirurgicheskogo lecheniya postradavshih s tyazheloj sochetannoj travmoj zhivota]. Travmatologiya i ortopediya Rossii. 2004; 2–3: 20–2 (in Russ.).
2. Abdominal trauma: a guide for doctors [Abdominal’naya travma: rukovodstvo dlya vrachej (Pod red. A. S. Ermolova, M. Sh. Hubutiya, M. M. Abakumova)]. Moskva: Vidar-M. 2010: 504 s (in Russ.).
3. Urman M. G. Injury of the abdomen [Travma zhivota]. Perm: IPK «Zvezda». 2003: 259 s (in Russ.).
4. Singayevsky A. B., Danilov A. M., Sigua B. V., Yalda K. D. Features of diagnosis of injuries of the lumbar region, accompanied by the formation of retroperitoneal hematomas [Osobennosti diagnostiki ranenij poyasnichnoj oblasti, soprovozhdayushchihsya obrazovaniem zabryushinnyh gematom]. Mezhdunarodnyj forum «Hirurgi protiv terrorizma. Hirurgiya povrezhdenij. Oshibki, opasnosti, oslozhneniya»: tezisy dokl. Moskva: 2016: 165–6 (in Russ.).
5. Borisov M. B., Denisenko V. V., Grebnev A. R. et al. Treatment of fractures of pelvic bones in combination with damage of pelvic organs [Lechenie perelomov kostej taza v sochetanii s povrezhdeniem vnutritazovyh organov]. Mezhdunarodnaya konf. travmatologov i ortopedov «Primenenie sovremennyh tekhnologij lecheniya v rossijskoj travmatologii i ortopedii»: tezisy dokl. Moskva. 2016: 30–1 (in Russ.).
6. Lazarev A. F., Borozda I. V. Massive retroperitoneal bleeding in fractures of pelvic bones [Massivnoe zabryushinnoe krovotechenie pri perelomah kostej taza]. Vestnik travmatologii i ortopedii im. N. N. Priorova. 2016; 2: 68–76 (in Russ.).
7. Yoshihara I. I., Yoneoka D. Demographic epidemiology of unstable pelvic fracture in the United States from 2000 to 2009: trends and in-hospital mortality. J Trauma Acute Care Surg. 2014; 76 (2): 380–5.
8. Hauschild O., Strohm P. C., Culemann U. et al. Mortality in patients with pelvic fractures: results from the German pelvic injury register. J Trauma. 2008; 64 (2): 449–55.
9. Cullinane D. C., Schiller H. J., Zielinski M. D. et al. Eastern Association for the Surgery of Trauma practice management guidelines for hemorrhage in pelvic fracture-update and systematic review. J Trauma. 2011; 71 (6): 1850–68.
10. Advanced trauma life support (ATLS®): the ninth edition. ATLS Subcommittee; American College of Surgeons’ Committee on Trauma; International ATLS working group. J Trauma Acute Care Surg. 2013; 74 (5): 1363–6.
11. Lipinsky J., Lasek J. Modern approach to management of patients following major trauma. Przegl Lek. 2000; 57 (Suppl 5): 120–3.
12. Tanaka T., Kitamura N., Shindo М. Trauma care system in Japan. Injury. 2003; 34 (9): 699–703.
13. Nast-Kolb D. Intramedullary nailing in polytrauma. Pro and contra early management. Unfallchirurg. 1997; Bd 100 (Н 1): S80–4.
14. Shere-Wolfe R. F., Galvagno S. M., Grissom T. E. Critical care considerations in the management of the trauma patient following initial resuscitation. Scand J Trauma Resusc Emerg Med. 2012; 20: 68.
15. Pape H. C., Lefering R., Butcher N. et al. The definition of polytrauma revisited: an international consensus process and proposal of the new «Berlin definition». J Trauma Acute Care Surg. 2014; 77 (5): 780–6.
16. Rotondo M. F., Schwab C. W., McGonigal M. D. et al. «Damage cоntrol»: An approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma. 1993; 35 (3): 375–82.
17. Schreiber M. A. The beginning of the end for damage control surgery. Br J Surg. 2012; 99 (Suppl 1): 10–1.
18. Rossaint R., Bouillon B., Cerny V. et al. Management of Bleeding Following Major Trauma: An Updated European Guideline. Crit Care. 2010; 14 (2): R52.
19. Gumanenko E. K. Combined trauma from the position of an objective assessment of the severity of injuries [Sochetannye travmy s pozicii ob”ektivnoj ocenki tyazhesti travm]. Avtoref. dis. dokt. med. nauk. Leningrad. 1992: 28 s (in Russ.).
20. Gumanenko E. K., Suprun T. Yu., Boyarintsev V. V. Comprehensive assessment of the severity of injuries [Kompleksnaya ocenka tyazhesti travm. Metodicheskie rekomendacii: «Mekhanicheskie travmy i ognestrel’nye povrezhdeniya»]. Saint-Petersburg: Voenno-medicinskaya akademiya. 1995: 43 s (in Russ.).
21. Baker S. P., О’Neill B., Haddon W., Long W. B. The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974; 14 (3): 187–96.
22. Kolesnikov V. V., Onishchenko N. S., Dushkin O. F. Use of the anti-shock suit «Kashtan» in the treatment of severe combined trauma [Ispol’zovanie protivoshokovogo kostyuma «Kashtan» v lechenii tyazheloj sochetannoj travmy]. Vestnik travmatologii i ortopedii im. N. N. Priorova. 2002; 2: 9–13 (in Russ.).
23. Kolesnikov V. V., Rakhimov B. M., Galkin I. V. et al. Experience of treatment of victims with severe combined abdominal trauma accompanied by retroperitoneal hematomas [Opyt lecheniya postradavshih s tyazheloj sochetannoj travmoj zhivota, soprovozhdayushchejsya zabryushinnymi gematomami]. Tol’yattinskij medicinskij konsilium. 2011; 3/4: 111–3 (in Russ.).
24. Kolesnikov V. V., Guselnikova M. A. Severe combined trauma and DIC-syndrome — resuscitation strategy of hemostasis [Tyazhelaya sochetannaya travma i DVS-sindrom — reanimacionnaya strategiya gemostaza]. Tromboz, gemostaz i reologiya. 2014; 2; 37–43 (in Russ.).