Therapeutic management of retroperitoneal hematoma

Therapy of retropentoneal hematoma is discussed controversially. In the lit erature mostly case reports are being reported. On the one hand surgical re vision of the retroperitoneum is not advised because of the possibility of uncontrollable bleeding. On the other hand hemostasis by a tamponade is rec ommended. Concerning the therapeutic strategy classification of retroperito neal hematomas in three zones - central, flank and pelvic-zone - is advised . In the case of a hematoma of the centralzone surgery is Controversially d iscussed is the treatment of hematomas of the pelvic area. Between 1991-199 7 18 patients with a retroperitoneal hematoma under-went surgery in our hos pital. Indications for an operative treatment were decrease of Hb under 8 m g/dl (n = 5), clinical signs of shock (n = 5) and volume of free abdominal fluid above 500 ccm (n = 4). 17 patients were; treated by removal of the he matoma. In six cases a tamponade was necessary Intraoperatively one patient had only a small amount of hematoma so that no revision of the: retroperit oneum was performed. Postoperatively two patients died because of pulmonary embolism and septic shock after a retroperitoneal abscess. According to ou r own experience we would, advise conservative treatment of retroperitoneal hematoma because in most cases there is venous bleeding which will stop sp ontaneously by : autotamponade After an operative revision extensive wounds result with I a high-risk of infection..