CNKKCSM Rare case of retroperitoneal hematoma managed.pptx

Rare case of retroperitoneal hematoma

1. A STAB IN THE FLANK !! RETROPERITONEAL HEMATOMA COMMUNICATING INTO THE CAECUM !! A CASE REPORT Presentor : Dr. Krishna K umar Final Year PG UNIT S1 Under the Aegis of PROF Dr. S.P. GAYATHRE MS.,D.G.O HEAD OF THE DEPARTMENT DEPARTMENT OF GENERAL SURGERY STANLEY MEDICAL COLLEGE AND HOSPITAL

2. CASE HISTORY AND EXAMINATION 28/M H/o Stab injury – right flank. Sustained – 11 PM – 13/05/24 Presented – 12 AM – 14/05/24 PRESENTING COMPLAINTS : C/o Abdominal pain Diffuse Severe stabbing pain Radiating to the back H/o Haematochezia on admission – 2 bouts, 200 ml each No H/o Nausea, vomiting No H/o Chest pain, breathlessness No H/o Loss of consciousness No H/o seizures/headache/ENT bleed

3. CASE HISTORY AND EXAMINATION No H/o previous surgeries No H/o comorbidities Not a smoker or alcoholic No previous drug allergy CLINICAL EXAMINATION : On examination Conscious Oriented Afebrile Dehydrated Pallor present

4. CASE HISTORY AND EXAMINATION VITALS : Pulse Rate – 114/min Low volume Thready Blood Pressure – 90/60 mmHg SpO2 – 98 % in Room air Respiratory Rate – 38/min GCS – 15/15

5. CASE HISTORY AND EXAMINATION SECONDARY SURVEY : Chest compression - Negative Pelvic compression - Negative Spinal tenderness - Negative PER ABDOMEN EXAMINATION : INSPECTION Abdomen distended Umbilicus in midline, inverted Lower abdomen not moving with respiration Stab wound – 2 x 2 cm noted over right flank 4 cm above and lateral to Anterior superior iliac spine Not actively bleeding, No exit wound No other external injuries noted

6. CASE HISTORY AND EXAMINATION PALPATION Diffuse tenderness – maximal over right iliac fossa Localised guarding over right iliac fossa No rigidity Depth of stab wound > 15 cm AUSCULTATION : Bowel sounds sluggish EXTERNAL GENITALIA : Normal DRE : Frank blood noted No rectal breach noted DIAGNOSIS : STAB INJURY TO THE RIGHT FLANK/ ?HOLLOW VISCOUS PERFORATION

7. INTRAOPERATIVE FINDINGS Patient resuscitated with iv fluids and shifted to OT immediately at 12:45 AM Taken up – Emergency exploratory l aparatomy 2 packed cells and FFP transfused intraoperatively Findings – Hemoperitoneum – 200 ml Contusion – Anterior wall of Caecum 2 Rents - parietal peritoneum – adjacent – right paracolic gutter Non expanding retroperitoneal hematoma – between bilateral common iliac vessels extending into the pelvis. Solid organs, remaining bowel and mesentery normal Procedure Done : Ileotransverse anastomosis with ileal transection and peritoneal lavage

8. INTRAOPERATIVE FINDINGS Patient resuscitated with iv fluids and shifted to OT immediately at 12:45 AM Taken up – Emergency exploratory l aparatomy 2 packed cells and FFP transfused intraoperatively Findings – Hemoperitoneum – 200 ml Contusion – Anterior wall of Caecum 2 Rents - parietal peritoneum – adjacent – right paracolic gutter Non expanding retroperitoneal hematoma – between bilateral common iliac vessels extending into the pelvis. Solid organs, remaining bowel and mesentery normal Procedure Done : Ileotransverse anastomosis with ileal transection and peritoneal lavage

9. POST OPERATIVE CARE Patient extubated and shifted to Hybrid ICU Post operative vitals stable throughout Girth showed decreasing trend Bowel sounds resumed on day 3 Liquid and Soft solids started – Days 4 and 5 Pelvic and Anastomotic Drains removed sequentially Patient discharged on Day 10 On followup , patient doing well.

10. DISCUSSION

11. THANK YOU