Particularities of posttraumatic retroperitoneal hemorrhage in pelvic fractures

Abstract

Aim: To study the particularities of posttraumatic retroperitoneal hemorrhage in pelvic fractures. Material and methods: We present the analysis of patients with pelvic fractures and retroperitoneal hemorrhages (n=201). The average age of patients was 38,26±15,03 years. Clinical examination (n=152) and forensic-medical examination (n=49) was carried out for evaluation of the volume and source of retroperitoneal hemorrhages. Patients with stable hemodynamic were examined by the standard scheme: pelvic X-rays, USG, CT. Pelvic injuries were divided according to M.Tile classification, retroperitoneal hemorrhage – according to zonal Sheldon classification. Results: Localization and volume of the pelvic retroperitoneal hematoma was determined by the source of bleeding, spreading according to pelvic ring instability, severity of internal organs injuries and pelvic vessels lesions. Pelvic fractures: type A - 75(37,31%), B - 55(27,36%), C - 71(35,32%). It was established that pelvic retroperitoneal hemorrhages were the most common and numerous – in 130 (64,67%) patients. The main sources of pelvic retroperitoneal hemorrhages were pelvic fractures with venous plexus lesions (type B, C, n=126) and urinary bladder injury (n=35). We used conservative treatment in pelvic venous hemorrhages (147 from 152 patients) to stop pelvic bleeding: early pelvic stabilization, patient position without active motions, hemostatic drugs. If conservative treatment was not effective in arterial bleeding (n=5), we used pelvic packing, vessel ligation, etc. Revision of pelvic bleeding was not performed. It was impossible to determine exactly the source of spreading (46,6%) retroperitoneal hemorrhage even by forensic-medical examination. Pelvic stabilization by device for external fixation performed at admission allowed to prevent massive intrapelvic hematomas and complications in patients with pelvic fractures (type B, C). Conclusions: the particularities of posttraumatic retroperitoneal hemorrhage in pelvic fractures are their massive volume, spreading, predomination of venous bleeding (88%). Conservative treatment was effective in 96,7% of venous pelvic bleeding. Early pelvic stabilization prevents massive retroperitoneal hemorrhages and posttraumatic complications.