Severity, challenges, and outcome of retroperitoneal hematoma in a Nigeria Tertiary Hospital

Abstract

Background: Retroperitoneal hematoma (RH) can present as an acute life‑threatening condition, report on RH in low‑income countries are lacking.

 Objective: We present the severity, pattern, challenges, and outcome of RH in a low‑resource country such as Nigeria.

 Methods: This was a retrospective observational study of all patients with blunt or penetrating abdominal injury needing surgery, patients with RH among them were analyzed.

Results: In the last one decade spanning 2005–2015, our operation database record showed that 247 patients had exploratory laparotomy for blunt and penetrating abdominal trauma. Out of the 115 patients with complete record available, only 43 had RH. The median age of the patients was 30 years, and the most affected age group was 20–29 years. Female to male ratio was 1:13. Only eight patients (18.6%) reached the hospital from the accident site within the first “Golden Hour” of accident, which is the first 1 h postrauma during which treatment intervention believed to have the best outcome. Only two patients (4.7%) got to operating theater within 1 h of reaching hospital. None of our patients had preoperative diagnosis of RH; overall, mortality was two patients (4.7%).

 Conclusion: Logistical infrastructural inadequacies such as lack of sterile theater bundle and drapes/nonavailability or busy theater space caused delay for patients between presentation in the Accident and Emergency Center and operating theater. None of our patients had a preoperative diagnosis of RH because of lack of access to computerized tomography scan dedicated to trauma in Accident and Emergency Center. The overall mortality of 4.7% in this study, which is on the low side, tends to suggest that mostly mild and stable cases which can make it to the operating table were eventually operated upon.

 Keywords:  Nigeria, outcome, prehospital care, retroperitoneal hematoma, tertiary institution, trauma