title: A novel approach to the treatment of gunshot injuries to the sacrum.
abstract: Two patients (a 17-year-old male and a 19-year-old female) sustained single gunshot wounds to the abdomen. Given the nature of their wounds and presumed peritoneal penetration they were taken urgently to the operating room for exploratory laparotomy. Both patients sustained multiple intra-abdominal injuries including gastric and small and large bowel perforations. Given the extensive nature of these injuries both patients required bowel resections. Upon further exploration they were both noted to have significant bleeding from the bony aspect of their sacrum. A surgical hemostat (CoStasis; Cohesion Technologies, Inc., Palo Alto, CA) (4.5-9.0 cm3) was directly applied to the injured area of the sacrum in both cases after standard surgical hemostatic techniques were unsuccessful. After application no further attempts of hemostatic control by standard methods were attempted. In both cases the sacral bleeding ceased without any further surgical intervention. Postoperatively neither patient rebled from the sacral injuries. Penetrating injuries to the sacrum can be life threatening and difficult to control with standard surgical hemostatic techniques. CoStasis, a new surgical hemostat, was effective in obtaining immediate and definitive hemostatic control. Future prospective trials on the use of CoStasis in trauma patients are warranted.
authors.affiliation: R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Dunne
authors.forename: Grant V
authors.initials: GV
authors.lastname: Bochicchio
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Scalea
mesh_terms: D000293:Adolescent; D000328:Adult; D002626:Chemistry, Pharmaceutical; D003082:Colectomy; D003094:Collagen / Q000737:chemistry / Q000627:therapeutic use*; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use; D006465:Hemoperitoneum / Q000188:drug therapy* / Q000209:etiology*; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D007422:Intestines / Q000293:injuries*; D008297:Male; D009104:Multiple Trauma / Q000150:complications* / Q000601:surgery*; D012447:Sacrum / Q000293:injuries*; D013270:Stomach / Q000293:injuries*; D013917:Thrombin / Q000737:chemistry / Q000627:therapeutic use*; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000150:complications* / Q000601:surgery*
chemical_list: C415302:CoStasis Surgical Hemostat; D003094:Collagen; D013917:Thrombin