Zone I retroperitoneal hematoma identified by computed tomography scan as an indicator of significant abdominal injury

Objective. All zone I retroperitoneal hematomas (Z1RPHs) identified at lapa rotomy for blunt trauma traditionally, require exploration. The purpose of this study was to correlate patient outcome after blunt abdominal trauma wi th the presence of Z1RPH diagnosed on admission computed tomography (CT) sc an. Methods. This is a retrospective review of patients with blunt trauma who w ere admitted to a Level 1 trauma center and who underwent CT scan, during a 40-month Period. All scans with a traumatic injury were reviewed to identi fy and grade Z1RPH as mild, moderate, or severe. Patients requiring of oper ative treatment were compared with those who were observed. Statistical ana lysis was performed with Student's t test and chi-square test, with P < .05 considered significant. Results. Eighty-five (15.5 %) of the CT scans were positive for Z1RPH. None of the 50 patients with a mild Z1RPH had their treatment altered. Of the 2 9 patients with a moderate or. severe Z1RPH, 8 required celiotomy. The pati ents requiring celiotomy had significant elevations of solid viscus score ( SVS) (4.9 +/- 1.6 versus 1.8 +/- 0.3), abdominal Abbreviated Injury Scale ( 3.8 +/- 0.3 versus 2.6 +/- 0.3), and transfusion requirements (13 +/- 4 ver sus 2 +/- 1). All patients (N = 4) with an SVS >4 required operative treatm ent. Seventy-two percent of patients with more than 1 intra-abdominal injur y required abdominal exploration. Conclusions. The presence of a moderate or severe Z1RPH and more than 1 int ra-abdominal injury or an SVS >4 on admission CT scan is an important radio graphic finding: This injury pattern should be considered a contraindicatio n for nonoperative treatment of the associated solid organ injury.