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Outline –General approach. –Anatomical boundaries. –Retroperitoneal Zones. –Cases. –Surgical Exposure.
Retroperitoneal Injury Approach. Mechanism of injury. –Blunt abdominal injury. »Mostly non-operative management. –Penetrating abdominal injury. »Mostly requires exploration.
Retroperitoneal Injury Anatomical boundaries. –The Anterior Abdomen. –The Flank. –The Thoracoabdominal area. –The Box.
Retroperitoneal Injury Anatomical boundaries.
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.
Retroperitoneal Injury Case 1: –Trauma laparotomy. –Splenectomy. –Zone 1 hematoma. –Zone 2 hematoma. –Zone 3 hematoma.
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.
Retroperitoneal Injury Case 2: –Trauma laparotomy. –Small bowel injury. –Zone 1 hematoma. Stable. Unstable.
Retroperitoneal Injury Case 2: –Trauma laparotomy. –Small bowel injury. –Zone 2 hematoma. Stable. Unstable.
Retroperitoneal Injury Case 2: –Trauma laparotomy. –Small bowel injury. –Zone 3 hematoma. Stable. Unstable.
Retroperitoneal Injury Left medial visceral rotation.
Retroperitoneal Injury Mattox maneuver
Retroperitoneal Injury Right medial visceral rotation.
Retroperitoneal Injury Cattell-Braasch manoeuvre
Discussion & Questions
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