- Disadvantages of Laparotomy:
- ligation of specific bleeding vessels in pelvic hematomas may not be
technically feasible
- extensive collateral flow of hypogastric system with in pelvis prevents
hypogastric artery ligation from being effective;
- ligation of both hypogastric arteries reduces mean arterial pressure in
distal arteries by < 25%;
- laparotomy breaches peritoneum, which contains the hematoma;
- w/ laparotomy, extraperitoneal hemorrhage may worsen due to rapid
decompression of tamponade;
- Treatment Options:
- consider preoperative
angiography and embolization which may decrease
risk of surgery or eliminate need for surgery;
- bilateral hypogastric artery embolization may be effective in controlling
blood loss but may lead buttocks ischemia;
