1. Retroperitoneal Injury

2. Retroperitoneal Injury
Outline
General approach.
Anatomical boundaries.
Retroperitoneal Zones.
Cases.
Surgical Exposure.

3. Retroperitoneal Injury
Approach.
Mechanism of injury.
Blunt abdominal injury.
Mostly non-operative management.
Penetrating abdominal injury.
Mostly requires exploration.

4. Retroperitoneal Injury
Anatomical boundaries.
The Anterior Abdomen.
The Flank.
The Thoracoabdominal area.
The Box.

5. Retroperitoneal Injury
Anatomical boundaries.

7. Zone 1

8. Zone 2

9. Zone 3

10. Retroperitoneal Injury

11. Retroperitoneal Injury
Case 1:
29 year old male, High speed MVC.
Ejected from the car.
Unconscious, Sat 88, BP:90/50, GCS 6, no external source of bleeding.
Intubated, bilateral chest tubes inserted, pelvis wrapped.
Sat 94, HR:110, BP:90/50.
FAST positive.

12. Retroperitoneal Injury
Case 1:
Trauma laparotomy.
Splenectomy.
Zone 1 hematoma.
Zone 2 hematoma.
Zone 3 hematoma.

13. Retroperitoneal Injury
Case 2:
42 year old male, abdominal stab.
Alert, Sat:99, BP:145/65, HR:89.
Has a 2 cm wound in the anterior abdominal wall.

14. Retroperitoneal Injury
Case 2:
Trauma laparotomy.
Small bowel injury.
Zone 1 hematoma.
Stable.
Unstable.

15. Retroperitoneal Injury
Case 2:
Trauma laparotomy.
Small bowel injury.
Zone 2 hematoma.
Stable.
Unstable.

16. Retroperitoneal Injury
Case 2:
Trauma laparotomy.
Small bowel injury.
Zone 3 hematoma.
Stable.
Unstable.

17. Retroperitoneal Injury
Left medial visceral rotation.

18. Retroperitoneal Injury
Mattox maneuver

19. Retroperitoneal Injury
Right medial visceral rotation.

20. Retroperitoneal Injury
Cattell-Braasch manoeuvre

21. Discussion & Questions