둔상에 의한 외상성 후복막 혈종

Retroperitoneal hematoma can be one of the most difficult problems encountered by trauma surgeon. Occasionally retroperitoneal hematoma has been the only finding at operation. The purpose of present study was to evaluate the early diagnosis and adequate management of retroperitoneal hematoma. A retrospective analysis of 31 traumatic retroperitoneal hematoma was performed in blunt trauma patients treated at the Department of Surgery, Asan Medical Center between May 1989 and May 1996. The range of age was from 16 to 59 years, and male to female ratio was 20:11. The most frequent type of blunt trauma was traffic accident(65%). The average initial injury severity score was 16.4(23 cases) with the average revised trauma score of 6.6(23 cases). The diagnostic methods of retroperitoneal hematoma were abdominal CT and explorative laparotomy. The locations of retroperitoneal hematoma were zone I in 16 cases, zone II in 17 cases, and zone III in 5 cases according to Kudsks classification. The associated injured organs were liver, kidney, and pancreas in descending order. The operative management was depended on the associated organ injury and the site of retroperitoneal hematoma. The complications was ARDS, acute renal failure, and congestive heart failure. The mor tality rate was 32% (10 cases), and the most common cause of death was multiorgan failure. In conclusion, the diagnosis of retroperitoneal hematoma was mainly made by abdominal CT, and the management and prognosis was depended on the associated organ injury and the location of retroperitoneal hematoma.