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Open Laparotomy to Control Hemorrhage in Pelvic Frx



- 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;
     - in one study there was a 60% mortality rate for laparotomy followed by angiography vs 25% mortality with angiography followed by laparotomy;

- 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



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Clifford R. Wheeless, III, MD on Sunday, August 4, 2013 11:37 am