부산대학교 도서관

The retroperitoneal space is a wide area lying posterior to the peritoneal cavity and contains a number of visceral (gastrointestinal and genitourinary), vascular, musculoskeletal, and nervous system structures, either wholly or partially. A simple location-based classification of traumatic retroperitoneal haematoma is as follows: central (Zone I), flank or peri-renal (Zone II), and pelvic (Zone III). The commonest Zone 1 aetiologies include injuries to the abdominal aorta and inferior vena cava, the coeliac axis, superior mesenteric artery, and proximal renal vasculature. A Zone II haematoma may result from injuries to the ascending or descending colon, duodenum, kidney, genito-urinary vascular structures, ureters, and muscular vessels. A Zone III haematoma is located in the pelvis which contains the rectum, the bladder, female genitalia, iliac vessels, and their tributaries. In general, all penetrating retroperitoneal haematomas must be explored. Blunt extraperitoneal haematomas are explored in Zone 1, explored in zone II if expanding, and in Zone III packed extra-peritoneally if expanding with post-packing angiography. An exception is a pre-operative CT scan that accurately grades a renal injury that can be managed expectantly. While it is beyond the scope of this chapter to describe the management of retroperitoneal vascular and blunt pelvic trauma; the focus will be on the management of kidney, ureter, pancreas, duodenum, and rectal injuries, which are managed according to their organ injury severity or anatomical location.