![]() ![]() The easiest way to dichotomize this diagnosis is to classify retroperitoneal hematoma as traumatic versus nontraumatic. The term “retroperitoneal hematoma” comprises several distinct clinical entities that are best characterized according to their underlying mechanisms. It houses connections to the diaphragm and bony pelvis. Also, the retroperitoneum contains vital musculoskeletal structures such as the psoas muscles, vertebra, quadratus lumborum, and iliacus muscles. ![]() ![]() The pelvic zone (Zone III) includes the bladder as well as a multitude of vascular structures, including a robust network for presacral veins. The perirenal zone (Zone II) begins lateral to the psoas muscles on either side and contains the kidneys, ureters, and portions of the colon. The central-medial zone (Zone I) falls between the two psoas muscles and contains midline structures such as the abdominal aorta, inferior vena cava, pancreas, and duodenum. An organizational schema dividing the retroperitoneal space into three different “zones” is widely prevalent in the surgical literature. The retroperitoneal space lies directly posterior to the peritoneal cavity. It is not uncommon for patients to present in frank hemorrhagic shock due to an underlying retroperitoneal hematoma. Often patients do not manifest clinically apparent signs and symptoms until a substantial amount of blood loss has occurred. This clinical entity is often occult and under-recognized by clinicians and is a cause of significant morbidity and mortality. Retroperitoneal hematoma is defined as bleeding into the retroperitoneal space. ![]()
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