[Retroperitoneal hematoma]. / Retroperitonealni hematom.

Diagnosis and management of retroperitoneal haematoma is the problem of controversy in actual moment. It appears most frequently in the range of polytrauma or various traumas of abdomen and retroperitoneal organs. Here we report our experience in management of retroperitoneal haematoma. During the ten year period (from 1979 to 1986) we treated surgically, at the department for surgery, 58 injured patients with retroperitoneal haematoma. In 5 cases explorative laparotomy was done, and in other 53 cases there were injuries of intraabdominal and retroperitoneal organs. The haematomas were caused by the ruptures of spleen, liver, kidneys, pancreas, duodenum, small bowel with mesenterium, large bowel, bladder, retroperitoneal large blood vessels and pelvic fractures. In 17 cases retroperitoneal haematoma was associated with the injury of one organ. In 36 cases there were injuries of two or more organs. Retroperitoneal haematoma was caused by blunt trauma in most cases. During the management there were some diagnostic difficulties. In diagnosis we use: clinical status, of patients, radiography, angiography, ultrasonography, but the most secure was laparotomy. There are two treatment approaches, operative and conservative. Retroperitoneal haematoma was a consequence of ruptured solid organs and retroperitoneal blood vessels, and associated with injuries of intraperitoneal organs. All this, mentioned above, is the reasons for detailed exploration of abdominal cavity.

[Injuries of the diaphragm]. / Povrede dijafragme.

Diaphragmal injuries are rare but serious. They are caused by traffic accidents, murder or suicide, fall from height, crush or blast injuries. Mechanisms of diaphragmal rupture may be various: sudden intraabdominal pressure increase, transferred strike force from pelvis (like "contra coup"), direct pressure on one or both hemitoracices, injuries piercing or sclopetar. Negative intraabdominal pressure is convenient for prolapse of abdominal organs into pleural cavity. Ruptures were more often of tendinous than muscular part of diaphragm, and they were more often on left side. Diaphragmal injuries can be: open--percutaneous (thoracoabdominal) and closed--subcutaneous. There are three types of thoracoabdominal injuries: thoracoabdominal, abdominothoracal and thoraco-retroperitoneal. Open diaphragm injuries are followed by shock, hemorrhages, cardiopulmonary disfunction, haematothoracic, peritonitis and other lesions. Closed diaphragmal injuries can be manifested clinically or latent. In the first stage of treatment there is a conservative approach (solving the shock) and in the second stage surgical approach. More often thoracotomy is better than laparotomy and the place of incision depends on localisation of injuries and clinical signs. During last 10 years we surgically treated 19 diaphragmal injuries with mortality rate of 15.9% (3). Most frequent causes of injuries were traffic accidents or sclopetar injury, and the predominant compression. Diaphragmal lesions were a part of thoracoabdominal injuries and politraumas with high mortality rate. The frequency of injuries of other abdominal organs was the following: spleen, lungs, liver, stomach, bowel, kidney, bladder, retroperitoneal blood vessels, legs, arms and pelvis. The treatment of diaphragmal injuries requires multidisciplinary, experienced surgery team with well equipped anaesthesiology and reanimation unit.

[Peacetime shooting injuries of the long bones]. / Mirnodopske sklopetarne povrede dugih kostiju

1. In our short reference we have shown the complete number of injuries sustained through shooting and we have indicated their enormous frequencies which can be regarded to be equal to those injuries in traffic communication. 2. While treating the injuries of extremities, as war injuries using the same principals as in war, we have obtained the best results and lessened the possibility of complication. 3. In the above cases for osteosinthesis of long bones, we held the principles of prolonged osteosinthesis while the primary osteosinthesis were use in special cases.

[Gunshot injuries of the gastroduodenal region]. / Strelne povrede gastroduodenalne regije

The injuries of the abdomen and in the region of duodenum sustained through shooting, present a delicate and difficult problem in treatment. During the years 1970/74, 375 cases were treated in our clinic, out of which 38 patients were with abdominal injuries while 12 cases were with gastro-duodenal injuries all derived through shooting. Special delicate problems represent the treatment of pancreas injuries if only the tissue of the pancreas is only made with simple stitch. The difficulties represent the treatment of injuried principal duct. Every attempt of sewing the principal duct leads to mortal inflamation of the gland. The problem of treatment of this kind of injury, apart from using different methods which are recommended in the world literature still remains open and unsolved.