Retroperitoneoscopic Evacuation of an Enormous Retroperitoneal Hematoma in a Trauma Patient

Konstantinos G Tsalis, Phd, George X Vrakas, MD, Zambia Koukouritaki,, MD, Abraham Dimoulas, MD, George Roidos, MD, Dimitrios Raptis, MD, Charalampos N Lazaridis, PhD. D’ Surgical Department Aristotle University of Thessaloniki, Greece

Introduction: Abdominal Compartment Syndrome (ACS) as a result of trauma is a challenging surgical problem. Evacuation of as much of abdominal content is possible may contribute to lowering the intra-abdominal pressure(IAP).
Aim: Aim of our study is to present our experience with retroperitoneoscopic evacuation of a huge retroperitoneal hematoma in a trauma patient with ACS.
Patients- Method: A 20-year-old male was referred to our department after spending 2 months in the ICU with an open abdomen. He underwent an initial exploratory laparotomy with liver packing after which the abdomen was left open. An enormous retroperitoneal hematoma wouldn’t allow closure of the abdomen. To restore abdominal domain and decrease intra-abdominal pressure evacuation of retroperitoneal hematoma was attempted, through a single 20mm incision, using video-assisted technique by irrigation-suction and removal of clots with lap forceps. Five sessions of retroperitoneoscopy were performed after which a repeated abdominal CT showed almost complete evacuation of the hematoma. At the first one a total amount of 450ml of blood clots was removed and the IAP fell from 20mm Hg to 10mm Hg. . Finally, the abdomen was closed using the ABRA system.
Conclusions: Retroperitoneoscopic evacuation of a huge retroperitoneal hematoma can contribute to lowering the IAP and closure of the abdomen in patients with ACS. To our knowledge this is the first report of video assisted evacuation of a retroperitoneal hematoma