title: Intra-abdominal injury is easily overlooked in the patients with concomitant unstable hemodynamics and pelvic fractures.
abstract: BACKGROUND
  Transcatheter arterial embolization (TAE) is usually necessary in the management of hemodynamically unstable patients with concomitant pelvic fractures. Given the critical conditions of such patients, TAE is at times performed only according to the results of a primary evaluation without computed tomographic (CT) imaging. Therefore, the evaluation of associated intra-abdominal injuries (IAIs) might be insufficient. Clinically, some patients have required post-TAE laparotomy due to further deterioration. In this study, we attempted to determine a feasible protocol for post-TAE observation.
  
  
  METHODS
  This study focused on patients who received TAE to achieve hemostasis of retroperitoneal hemorrhage and who did not undergo CT imaging due to their unstable hemodynamics. The characteristics of patients with and without associated IAIs requiring post-TAE laparotomy were compared. We also analyzed the effects of the timing of post-TAE CT imaging on patients with IAIs requiring surgery.
  
  
  RESULTS
  A total of 41 patients were enrolled in the study. Of these patients, all of whom underwent primary TAE without preprocedure CT imaging; 15 patients (15/41, 36.6%) required post-TAE laparotomy due to further deterioration. Comparisons between the 2 patient groups revealed no significant differences in the rate of endotracheal intubation (80.0% vs 65.4%, P=.480), loss of consciousness (66.7% vs 73.1%, P=.730), or abdominal symptoms (20.0% vs 23.1%, P=1.000).
  
  
  CONCLUSIONS
  In the management of hemodynamically unstable patients with concomitant pelvic fractures, greater attention should be paid to associated IAIs. Early CT imaging is encouraged after the patient's hemodynamic status is stabilized with TAE.
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: drfu5564@yahoo.com.tw.
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Fu
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: victorgoer@hotmail.com.
authors.forename: Chien-An
authors.initials: CA
authors.lastname: Liao
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: Surgymet@gmail.com.
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Liao
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: sckang@adm.cgmh.org.tw.
authors.forename: Shih-Ching
authors.initials: SC
authors.lastname: Kang
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: shangyusubmit@gmail.com.
authors.forename: Shang-Yu
authors.initials: SY
authors.lastname: Wang
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: yupao@cgmh.org.tw.
authors.forename: Yu-Pao
authors.initials: YP
authors.lastname: Hsu
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: linbc@cgmh.org.tw.
authors.forename: Being-Chuan
authors.initials: BC
authors.lastname: Lin
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: kcyuan@cgmh.org.tw.
authors.forename: Kuo-Ching
authors.initials: KC
authors.lastname: Yuan
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: m7017@cgmh.org.tw.
authors.forename: I-Ming
authors.initials: IM
authors.lastname: Kuo
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: DETV090@yahoo.com.tw.
authors.forename: Chun-Hsiang
authors.initials: CH
authors.lastname: Ouyang
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D000328:Adult; D002985:Clinical Protocols; D004621:Embolization, Therapeutic / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D050723:Fractures, Bone / Q000150:complications*; D006471:Gastrointestinal Hemorrhage / Q000628:therapy; D006439:Hemodynamics; D006801:Humans; D007813:Laparotomy; D008297:Male; D010384:Pelvic Bones / Q000293:injuries*; D014057:Tomography, X-Ray Computed