"Separate and distinct from retroperitoneal exploration for ligation, Harald Tscherne's group from Hannover, Germany have authored compelling reports of success of extraperitoneal packing on small numbers of patients. It is difficult to amass large sample sizes in the study of such a relatively rare injury.
They do a retroperitoneal approach but they don't try to clamp off bleeders. They will fix whatever fractures they can easily address (e.g. symphysis pubis and even mobilize the colon in order to approach the posterior pelvis and perform fixation). They are mainly scooping out clot and packing aggressively. A running suture or towel clip abdominal closure is performed and they return in 24 hours to remove packs."
This is definitely not what we do in London. We pack the pelvis intraperitoneally without entering the retroperitoneum. This, in addition to some external stabilization of the pelvis, (in theory) allows tamponade of venous and fracture bleeding. The patient then goes to angio for control of any larger arterial haemorrhage. This is only used in those patients whose abdomen is opened for control of intraperitoneal haemorrhage. It is not a procedure undertaken in its own right for haemorrhage control.
In our experience when you open the retroperitoneum in these cases you are not scooping out clot but swimming in a red lake.
We "replace" the clots by by our extraperitoneal
tamponades or better, we try to put in tamponades before a huge amount of
growing clots is able to rise and produce problems. The "genesis"
of the retroperitoneal hematoma is impressively to be watched by frequent
repetition of the abdominal ultrasound.