Henao and Aldrete offered a management algorithm for the stable trauma patient with a retroperitoneal hematoma. The authors are from the University of Alabama.


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.


To read more or access our algorithms and calculators, please log in or register.