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Titolo:
ABDOMINAL PACKING FOR SEVERE HEMORRHAGE
Autore:
STYLIANOS S;
Indirizzi:
RAINBOW BABIES & CHILDRENS HOSP,DIV PEDIAT SURG,3959 BROADWAY,RM 207 N NEW YORK NY 10032 COLUMBIA UNIV,COLL PHYS & SURG,DEPT SURG NEW YORK NY 00000
Titolo Testata:
Journal of pediatric surgery
fascicolo: 2, volume: 33, anno: 1998,
pagine: 339 - 341
SICI:
0022-3468(1998)33:2<339:APFSH>2.0.ZU;2-L
Fonte:
ISI
Lingua:
ENG
Soggetto:
PLANNED REOPERATION; INTRAABDOMINAL HEMORRHAGE; PERIHEPATIC PACKING; HEPATIC HEMORRHAGE; TRAUMA; INJURIES; LAPAROTOMY; REEXPLORATION; COAGULOPATHY; MANAGEMENT;
Keywords:
HEMORRHAGE; PACKING; COAGULOPATHY; TRAUMA;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
24
Recensione:
Indirizzi per estratti:
Citazione:
S. Stylianos, "ABDOMINAL PACKING FOR SEVERE HEMORRHAGE", Journal of pediatric surgery, 33(2), 1998, pp. 339-341

Abstract

Background: Diffuse abdominal or retroperitoneal hemorrhage is potentially lethal particularly when associated with coagulopathy, hypothermia, and acidosis. Temporary abdominal packing (PACKS) can control hemorrhage and provide crucial time to correct these physiological and metabolic derangements. Methods: The author reviewed the combined experience of pediatric surgeons at 13 institutions to determine the efficacyof this technique. Results: Twenty-two patients with refractory hemorrhage (ages, 6 days to 20 years) were treated with PACKS. The etiologyof hemorrhage was trauma in 13, solid organ tumor bed in four, liver bleeding during necrotizing enterocolitis surgery in two, hemorrhagic pancreatitis in one, iliac artery injury while on extracorporeal membrane oxygenation (ECMO) in one, and biliary reconstruction after liver transplant in one. The anatomic site of hemorrhage was the liver or hepatic veins in 14, retroperitoneum or pelvis in seven, and the pancreatic bed in one. Twenty patients (91%) were coagulopathic, hypothermic,and acidotic at the time of packing. Fifteen patients (68%) had PACKSinserted during a primary operative procedure, whereas seven patients(32%) had PACKS inserted during a reexploration for persistent hemorrhage. The mean volume of intraoperative transfusion before PACKS was 190 mL/kg (range, 50 to 600). Primary fascial closure was accomplished in 12 (55%) patients, and temporary skin closure or prosthetic material was used in the other ten. PACKS controlled hemorrhage in 21 of 22 (95%) patients. Removal of PACKS was possible within 72 hours in 18 (82%) patients. No patient experienced rebleeding after PACKS removal; however, two patients died with PACKS in place. An abdominal abscess developed in seven patients (32%); all were successfully drained. Eighteen patients (82%) survived after abdominal packing. Two deaths were caused by multisystem organ failure, one was caused by cardiac failure from uncorrectable cardiac anomalies, and one was from exsanguination after blunt traumatic liver injury. There were no differences in volume of intraoperative blood product transfusion, time to initiate PACKS, physiological status, or type of abdominal closure between survivors and nonsurvivors. Conclusion: The author concludes that temporary abdominal packing can be life saving in children with refractory abdominal or retroperitoneal hemorrhage associated with coagulopathy, hypothermia, and acidosis. Copyright (C) 1998 by W.B. Saunders Company.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 04/07/20 alle ore 12:31:28