Penetrating lateral retroperitoneal haematoma - do you go in? PROB NOT

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As described, this case is problematic with differing  opinions.    One major 
concern for me is that the  nephrectomy  rate in similar patients is HIGHER 
if a kidney is explored  versus leaving Gerotas  fascia intact.  
 
In my hospital this case would involve a seasoned urologist (seasoned with  
trauma experience), would make the decision to explore the LATERAL  
retroperitoneum.    If I were alone with no experienced trauma  urologist, and as 
described, I would NOT explore the lateral stable  hematoma.  
 
One unknown issue is whether or not this hematoma is on the left or right,  
high or low.    I would try to predict just what might be  injured.    The 
possibilities include IVC,  segmental lumbar  vessels,  ascending lumbar vein, 
URETER, lateral kidney, iliac vein, iliac  artery, muscle bleeders.    
 
ALL of the above, in the stable patient can be observed at least the first  
24-36 hours.   Many of the above could cause the surgeon real headache  if 
explored.     
 
k

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