Abstract
An experience with 31 patients who developed major bleeding diatheses during laparotomy was reviewed. Management of the initial 14 patients was by standard hematologic replacement, completion of all facets of operation, and then closure of the peritoneal cavity, usually with suction drainage; only one patient survived. The subsequent 17 patients had laparotomy terminated as rapidly as possible to avoid additional bleeding. Major vessel injuries were repaired; ends of resected bowel were ligated; and holes in other gastrointestinal segments and the bladder were closed by purse-string sutures. One patient had a ureter ligated. Laparotomy pads (4-17) were then packed within the abdomen to effect tamponade, and the abdomen was closed under tension without drains or stomata. Following correction of the coagulopathy, the abdomen was re-explored at 15 to 69 hours in the 12 survivors. Definitive surgery then was completed: bowel resection and reanastomosis; ureter reimplantation; drains for bile, pancreatic juice, and urine; and stomata for bowel or urine diversion or decompression. Eleven of 17 patients, deemed to have a lethal coagulopathy, survived. This technique of initial abortion of laparotomy, establishment of intra-abdominal pack tamponade, and then completion of the surgical procedure once coagulation has returned to an acceptable level has proven to be lifesaving in previously non-salvageable situations.
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Selected References
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- Fabian T. C., Stone H. H. Arrest of severe liver hemorrhage by an omental pack. South Med J. 1980 Nov;73(11):1487–1490. doi: 10.1097/00007611-198011000-00021. [DOI] [PubMed] [Google Scholar]
- Feliciano D. V., Mattox K. L., Jordan G. L., Jr Intra-abdominal packing for control of hepatic hemorrhage: a reappraisal. J Trauma. 1981 Apr;21(4):285–290. doi: 10.1097/00005373-198104000-00005. [DOI] [PubMed] [Google Scholar]
- Harrigan C., Lucas C. E., Ledgerwood A. M., Mammen E. F. Primary hemostasis after massive transfusion for injury. Am Surg. 1982 Aug;48(8):393–396. [PubMed] [Google Scholar]
- Richards A. J., Jr, Lamis P. A., Jr, Rogers J. T., Jr, Bradham G. B. Laceration of abdominal aorta and study of intact abdominal wall as tamponade: report of survival and literature review. Ann Surg. 1966 Aug;164(2):321–324. doi: 10.1097/00000658-196608000-00020. [DOI] [PMC free article] [PubMed] [Google Scholar]