Zone 4 for retroperitoneal region

Q: The retroperitoneum is usually divided into three zones from a surgical perspective. What does zone 4 mean when it is mentioned?

Answer: The retroperitoneum is usually divided into 3 zones from the trauma or surgical perspective. When the surgeon speaks of Zone 4, it means more than one zone is involved. It may carry a higher mortality. It may affect the injury severity score. It may be interesting to learn that mortality is usually higher for blunt trauma than for stab wounds. The usual domino effect and cause of death are multiorgan failure (MSOF), hypovolemic shock, and sepsis. Other factors that may lead to death are a delay of surgery beyond 6 hours and the extent of the injury.

Besides zone 4, zone 1-only injury is also considered high risk.

#trauma

References:

1. Manzini N, Madiba TE. The management of retroperitoneal haematoma discovered at laparotomy for trauma. Injury 2014; 45:1378.

2. Manzini N, Madiba TE. The management of retroperitoneal haematoma discovered at laparotomy for trauma. Injury. 2014 Sep;45(9):1378-83. doi: 10.1016/j.injury.2014.01.026. Epub 2014 Feb 3. PMID: 24606980.