Endovascular control of ongoing pelvic hemorrhage after intraoperative arterial shunting and venous ligation in peripheral vascular trauma
Year: 2024
Type: article
Study design: Case Report
Abstract: An adult patient presented with multiple gunshot wounds to the pelvis and thighs. The patient arrived awake and alert but in advanced hemorrhagic shock. A left femoral Cordis was placed, and massive transfusion protocol was initiated. There was a robust response to resuscitation. Physical examination revealed gunshot wounds as outlined in figure 1. The right buttock wound had significant non-pulsatile, venous bleeding. The patient had palpable femoral pulses bilaterally and multiphasic left pedal signals by Doppler examination but absent right dorsalis pedis and posterior tibialis signals. Focused Assessment with Sonography in Trauma (FAST) examination showed free fluid in the hepatorenal space, though the abdomen was soft and non-tender. Abdominal and pelvic plain radiographs did not show pneumoperitoneum, pelvis disruption, or retained missiles. The patient was taken directly to the operating room, and an exploratory laparotomy was performed. There was no blood, succus, or urine in the peritoneal cavity and no retroperitoneal hematomas. There was a significant amount of dark blood staining the muscular tissue in the pelvis but no overt bleeding into the peritoneal cavity. After transabdominally packing the pelvis, we performed a right femoral cutdown. There was a destructive injury to the common femoral vein and a laceration to the posterior wall of the superficial femoral artery. Hemorrhage was slowed with direct pressure, but the patient remained tachycardic, hypotensive, and coagulopathic despite active blood product transfusion.
Source: Trauma Surgery & Acute Care Open
Institution: University of Colorado Anschutz
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,100
OpenAlex ID: W4404376423