Emergency War Surgery: The Survivalist's Medical Desk Reference by Department of the Army

Author:Department of the Army [Unknown]
Language: eng
Format: epub
Publisher: Skyhorse Publishing
Published: 2012-02-01T05:00:00+00:00

• Peritonealized rectal injuries are easily accessed transabdominally and should be repaired and protected with diversion.

• Hematoma in the perirectal space should be drained either transluminally by leaving the injury open or by placing presacral and/or intraabdominal drains.

Retroperitoneal Injuries

• Left medial visceral rotation moves the colon, pancreas, and small bowel to expose the aorta rapidly. Proximal aortic control can be rapidly obtained with compression or a clamp on the aorta at the hiatus, or through the left chest.

• Right medial visceral rotation (colon plus Kocher maneuver to elevate duodenum) exposes the subhepatic vena cava.

• Three zones of the retroperitoneum (Fig. 17-10).

I-Central, supracolic: explore for all injuries.

II-Central, infracolic: penetrating trauma, explore; blunt trauma, explore for expanding hematoma.

III-Lateral: blunt trauma, avoid exploration if possible because exploration increases the likelihood of opening a stable hematoma and, thus, precipitating nephrectomy. Explore for penetrating trauma.

• Gain proximal vascular control before entering the hematoma.

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