Packing for damage control of nontraumatic intra-abdominal massive hemorrhages.
BACKGROUND
The Damage Control Surgery (DCS) approach to massive intraperitoneal hemorrhage has been shown to significantly reduce the morbidity and mortality in severely injured trauma patients. We applied the same principles to patients who developed a massive hemorrhage and the "lethal triad" (acidosis, hypothermia, coagulopathy) during a surgical procedure in order to assess feasibility and efficacy of DCS on nontraumatic grounds.


METHODS
A retrospective analysis of eight consecutive cases was performed aimed at collecting information on laboratory parameters, fluids requirements, operative times, APACHE II score, damage control surgery procedure, angioembolization, morbidity, mortality, and need for repacking.


RESULTS
Average APACHE II score was 25.5 (predicted mortality rate = 54%); overall and early mortality in the nontraumatic group was nil, while the intra-abdominal septic (packing-related) complication rate was 12.5%.


CONCLUSIONS
Intra-abdominal packing was shown to be feasible, safe, and effective for patients with intra-abdominal nontraumatic massive hemorrhage, and the application of the principles of DCS may improve survival in cases of surgical hemorrhage with development of the lethal triad.
Acute Care and Trauma Surgery Unit, Maggiore Hospital Trauma Center, L.go Nigrisoli 2, 40133 Bologna, Italy. filippo.filicori@gmail.com
Filippo
F
Filicori
Salomone
S
Di Saverio
Marco
M
Casali
Andrea
A
Biscardi
Franco
F
Baldoni
Gregorio
G
Tugnoli
D018806:APACHE; D000328:Adult; D000368:Aged; D005260:Female; D006465:Hemoperitoneum / Q000601:surgery; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies