The occurence and detection of hemodynamically significant bleeding into the retroperitoneum in patients dying due to blunt traumatic-haemorrhagic shock
Abstract
Background: The occurrence of retroperitoneal bleeding and the manner of detection was retrospectively evaluated in patients with life-threatening traumatic bleeding. Methods: The cohort included patients who died in the Trauma Centre of the University Hospital Hradec Kralove in Czech Republic between 2008 and 2012 due to traumatic hemorrhagic shock.
Findings of retroperitoneal bleeding and the findings found for life (i.e., CT, FAST, pre-operative findings) were compared. Results: During the five-year period, deaths due to the post-mortem diagnosis of traumatic hemorrhagic shock were recorded in 75 patients, 26 of which (35%) were verified by post-mortem autopsy to have hemodynamically significant bleeding into the retroperitoneum (HSBR) from 31 sources.
HSBR was identified for life in 10 patients with HSBR (38.5%). Sensitivity was 55% in CT angiography and 36% in laparotomy without previous CT.
The sensitivity of laparotomy with surgical exploration of the retroperitoneum was 67%. A predisposing factor for hemodynamically significant bleeding into the retroperitoneum, which may escape the surgeon's attention, is high-energy blunt trauma to the trunk.
Conclusions: In the acute stage of treatment of patients with life-threatening bleeding due to high-energy blunt trauma, the surgeon has to decide whether the patient's condition allows CT and whether hematoma of the retroperitoneum should be revised surgically. However, in the present cohort few patients with HSBR underwent surgical exploration of the retroperitoneum because the hematoma was ascribed to the known injury of the pelvis and spine.