title: Therapeutic approaches in pelvic bleeding of neoplastic origin.
abstract: OBJECTIVE
  The aim of this study is to present the main - surgical and non-surgical - therapeutic approaches (or methods) used in the treatment of pelvic bleeding of neoplastic origin.
  
  
  METHODS
  analysis of the materials found in the literature on this subject.
  
  
  RESULTS
  Among the surgical methods used, hypogastric artery ligation is the oldest therapeutic approach in cervical bleedings of neoplastic origin. Due to the frequent recurrence of haemorrhages, mere ligation has been proven not to be sufficient, but necessitating the concomitant ligation of the lumbo-ovarian, round and uterosacral ligaments. In the case of severe bleedings, difficult to control, direct embolization of the hypogastric artery below the level of ligation is usually practiced. As for the non-surgical methods used, we chose to present uterine artery embolization and the application of haemostatic Mohs' paste. Uterine artery embolization consists in the permanent occlusion of the uterine arteries in neoplastic abundant haemorrhages, when the intervention includes the use of permanent embolic material. Stopping the bleeding within the first 24 hours from the embolization means that the intervention has been a success, and provides the patient with the possibility to continue the therapy protocol according to her stadialization. Recent studies of the Japanese researchers have indicated the possibility to use the Mohs' paste for haemostatic purposes on patients with cervical bleedings of medium intensity, in cases of advanced cervical cancer.
  
  
  CONCLUSIONS
  With severe haemorrhages - occurring spontaneously or during surgery - the emergency haemostatic intervention consists in the bilateral hypogastric artery ligation. With long-lasting haemorrhages of medium intensity, we usually resort to uterine artery embolization, since this is a minimally invasive method and may also be performed with abundant bleeding under emergency pressure. The application of the Mohs' paste for haemostatic purposes is a new therapeutic method, whose efficiency cannot be yet estimated.
authors.affiliation: University Emergency Hospital, Bucharest.
authors.forename: L R
authors.initials: LR
authors.lastname: Popovici
authors.affiliation: Dr. I. Cantacuzino Clinical Hospital.
authors.forename: A
authors.initials: A
authors.lastname: Ciulcu
authors.affiliation: University Emergency Hospital, Bucharest.
authors.forename: B
authors.initials: B
authors.lastname: Dorobat
authors.affiliation: University Emergency Hospital, Bucharest.
authors.forename: M
authors.initials: M
authors.lastname: Dumitraşcu
authors.affiliation: University Emergency Hospital, Bucharest.
authors.forename: V V
authors.initials: VV
authors.lastname: Horhoianu
authors.affiliation: University Emergency Hospital, Bucharest.
authors.forename: M
authors.initials: M
authors.lastname: Cirstoiu
mesh_terms: D002712:Chlorides / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D007564:Japan; D008026:Ligation / Q000379:methods; D008875:Middle Aged; D055357:Uterine Artery Embolization / Q000379:methods; D002583:Uterine Cervical Neoplasms / Q000150:complications*; D014592:Uterine Hemorrhage / Q000628:therapy*; D017967:Zinc Compounds / Q000627:therapeutic use*
chemical_list: D002712:Chlorides; C583017:Mohs' paste; D017967:Zinc Compounds
keywords: Mohs’ paste; hypogastric artery ligation; pelvic haemorrhage (pelvic bleeding); uterine artery embolization