A patient comes with renal trauma and is taken for explorative laparotomy. Kidney is not identifiable with hematoma/blood collection. Further IVU shows mildly discernable right kidney, left kidney shows normal uptake and wash out
|A||Do operative retrograde urogram|
|B||Ligate renal vessels, remove gerotas fascia and explore the wound explore the right kidney|
|C||Do a on table arteriogram|
This patient has developed post abdominal trauma retroperitoneal haematoma.
Retroperitoneal haematoma is classified into three zones according to these treatment options.
Zone I – (Central haemotoma) :-
The central zone includes IVC, aorta and proximal renal pedicle. As these vascular structures are critical hence they always need exploration and definite treatment to achieve survival.
Zone II (Lateral haemotoma)
This zone includes kidney, adrenal and muscle of lateral abdominal wall. Haematomas is this region do not have adequate space to expand and hence they restrict themselves forming a tamponading effect. Hence lateral haematomas are always irritated conservatively.
Zone III (Pelvic haematomas)
In pelvis, there are channel which are extremely friable and difficult to identify the site of hemorrhage in case of pelvic bleeding hence the treatment for pelvic haematoma is always, angio embolization or packing.
In this patient, best approach is to do a CT scan angiography and determine whether TF is zone I / Zone II haematoma and this treat accordingly.