Current therapy of injuries of the colon and retroperitoneum

Injuries of the colon and retroperitoneum are rarely observed after blunt a bdominal trauma and occur in about 5 - 20 % of the patients. The majority o f complications are due to initial misdiagnoses and a delay in treatment. L esions of the pancreas and duodenum are the most frequent diagnoses in the retroperitoneal space, while major vascular traumata or urogenital injuries are rare. Retroperitoneal hematoma are most likely due to pelvic fractures . The survival of patients after colon or retroperitoneal injuries depends on the severity of concomitant organ trauma, the time of diagnosis, and a s ituation-adapted therapeutic strategy. The treatment of the typical caudal retroperitoneal hematoma following pelvic fractures is conservative in most patients. Early pelvic stabilization, e.g., with external fixation, is rec ommended in these patients. Central retroperitoneal hematoma in the supra - or inframesocolic space should be treated surgically, as major vascular in juries are most likely in these patients. Duodenal or pancreatic injuries n eed surgical exploration in the majority of patients; the therapeutic spect rum ranges from simple sutures to pancreatoduodenal resection. The treatmen t of colon injuries depends on the degree of peritonitis and the severity o f concomitant trauma. Early diagnosed injuries are suitable for primary rep air, while deviation stomata or a Hartmann procedure with or without resect ion should be offered to patients with delayed diagnoses, peritonitis, or s evere concomitant diseases. Long-lasting procedures should be abandoned in the emergency situation; in these severe cases, laparotomy should be aimed towards primary "damage control" and followed by definite surgery after sta bilization of the patient.