Selection criteria:
(1) retroperitoneal hematoma present
(2) no signs of peritoneal irritation
(3) negative peritoneal lavage (or FAST examination)
(4) stable hemodynamics after initial resuscitation
Methods of analysis available for evaluating the hematoma:
(1) angiography
(2) ultrasound
(3) CT scan
Initial management: Observe the patient at bed rest for 3-4 hours.
If hemodynamically stable:
(1) Continue observation.
(2) If pelvic fractures are present consider external fixation.
If there is evidence of persistent bleeding (falling hematocrit, need to transfuse):
(1) Perform diagnostic angiography to identify bleeding vessels
(2) Attempt embolization of bleeding vessels
(3) If hemodynamically stable, continue with observation as above.
If unable to control bleeding and there are expanding hematomas , then perform exploratory surgery (see next algorithm).
If a retroperitoneal hematoma is nonexpanding then it probably does not need to be explored.
