Diagnosis and Treatment of Patients with Traumatic Retroperitoneal Hematoma Complicated with Bone Fractures

Objective: Traumatic retroperitoneal hematoma (RPH) is an underdiagnosed entity, turned to have a high mortality rate, when is not earlier diagnosed. Our aim was to analyze our experiences in patients with traumatic RPH complicated with bone fractures, and highlight the problems in diagnosis and treatment to facilitate the surgeon’s decision.

Methods: In this retrospective study, all cases who presented to the emergency room (ER) and/or admitted to our center with bone fractures complicated with RPH from January 2016 to December 2019 were included (4-years data). Data collected included age, hematoma zones, fracture production mechanisms, mortality, surgical intervention, bones lesions frequency, frequency of pelvic bone injuries, complications and biochemical and hematological analysis (e.g. hemoglobin (Hb), hematocrit (Ht), platelets (PLT), leukocytes (Leu), aspartate aminotransferase level (AST), alanine aminotransferase level (ALT) and creatinine (Cr). All RPHs were diagnosed using computed tomography scan.

Results: A total number of 173 RPH cases with bone fractures were included with a mean age of 48.80±1.40. Zone II and III (lateral and pelvic hematoma) bleed were the most common type of RPH. The main fracture production mechanism was road accident (n=110). The bone lesions frequency besides pelvis, was seen in lumbar vertebral fractures (e.g. 19 cases in 2016, 38 cases in 2017, 45 in 2018 and 40 in 2019), comparing with the other fractures, without any statistical significance. An important significance was seen for frequency of pelvic bone injuries, when comparing 2016 with 2018 year (p=0.040). Furthermore, the complications seem to have a statistical significance when 2016 year was compared with all the other years (p=0.030, p=0.035, p=0.052). Regarding the biochemical and hematological analysis, a statistical significance was seen at Hb (when 2016 was compared with 2017 year, p=0.007 and 2018 year, p=0.001), Ht (when 2016 was compared with 2017, p=0.054 and 2018, p=0.002), PLT (when 2016 was compared with 2018 year, p=0.0004, and 2019 year, p=0.002) and ALT (when 2016 was compared with 2017 year, p=0.026, and 2018 year, p=0.026). The highest mortality was registered in 2019 (n=11), being statistically significant in comparison with 2016 year (p=0.030). About 109 patients were treated conservatively, and 64 by surgical interventions.

Conclusion: There is a lack of evidence for the best management in RPH, conservative approaching being reserved only for patients who are stable. Therefore, traumatic RPH complicated with bone fractures, especially lumbar vertebral fractures, represent a life-threatening condition, early diagnosis and correct treatment is of upmost importance.