Monitoring and evaluation of intraperitoneal bleeding (IPB) by small portable ultrasonography during transcatheter arterial embolization (TAE) in abdominal-pelvic trauma patients with shock: as a monitor for early detection of increase of IPB.
OBJECTIVE
Blunt abdominal-pelvic trauma patients with shock often require transcatheter arterial embolization (TAE), and may also require surgery if intraperitoneal bleeding (IPB) becomes massive. Deciding whether the patient should undergo surgery is highly critical. We sometimes perform TAE without attention to IPB because it has been difficult to evaluate the volume of IPB exactly during TAE. Currently we use small portable ultrasonography (PUS) as a monitor of volume of IPB during TAE. The aim of this study is to clarify the usefulness of PUS for monitoring changes in IPB during TAE.


METHODS
We examined the volume of IPB by PUS during TAE without disturbing the operators of TAE. In our protocol, if the volume of IPB showed rapid increase we tried to perform a surgical procedure. The design of this study was a prospective case series study.


RESULTS
We examined 26 patients. Increase of IPB was detected in 3 cases; two were undergoing angiography for ileac and renal arteries when PUS indicated increase of IPB, which drew attention to their hepatic arteries. The other was examined initially for internal ileac artery and underwent surgery because of an increase of IPB. In the other 22 cases, we confirmed no increment of IPB by PUS and continued the procedure.


CONCLUSIONS
PUS is useful for deciding the order of therapeutic procedure, and is a useful monitoring instrument for increase of IPB.
Moriwaki
Yoshihiro
Y
Department of Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan. qqc3@urahp.yokohama-cu.ac.jp
Sugiyama
Mitsugi
M
Toyoda
Hiroshi
H
Kosuge
Takayuki
T
Takahashi
Ko
K
Iwashita
Masayuki
M
Matsuzaki
Shoichi
S
Tahara
Yoshio
Y
Suzuki
Noriyuki
N
D000007:Abdominal Injuries / Q000150:complications* / Q000000981:diagnostic imaging; D000293:Adolescent; D000328:Adult; D000368:Aged; D002404:Catheterization; D002648:Child; D042241:Early Diagnosis; D004621:Embolization, Therapeutic; D005260:Female; D006465:Hemoperitoneum / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D012769:Shock / Q000000981:diagnostic imaging / Q000209:etiology; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000000981:diagnostic imaging