A 30-year-old man sustains a high-velocity gunshot wound to the abdomen. Exploratory laparotomy reveals a retroperitoneal hematoma in Zone 1 (central, medial) with no expansion. What is the appropriate management?

• A Leave the hematoma undisturbed as it is not expanding
• B Explore the hematoma as all Zone 1 hematomas require exploration in penetrating trauma ✓
• C Apply packing and plan a second-look laparotomy in 48 hours
• D Perform an on-table angiogram and embolize if blush is seen

Explanation

Retroperitoneal hematomas are managed by zone. Zone 1 (central) hematomas are explored in all cases of penetrating trauma because of the high probability of major vascular or visceral injury. Zone 2 (lateral) and Zone 3 (pelvic) hematomas are explored only if expanding or pulsatile in blunt trauma, but Zone 1 always requires exploration in penetrating trauma regardless of stability.

Reference: Trauma by Mattox, Moore, and Feliciano, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.