How to Pack Gauzes into Intra-abdominal and Extraperitoneal Cavity for Difficult Abdominal Injuries?

Abstract

There have been incredible advances in surgical managements and radiologic interventions of a hemorrhagic control with severe abdominal organ injuries. However, it has been very challenging to stop the bleeding from some of the internal organs, such as a liver or pelvis. As those organs have plenty of vessel plexus inside, it has been very difficult to control the most of the bleeding applying surgical ligations and/or angioembolizations, because such tech-niques have a limitation on a reach all of the damaged vessels. Therefore, it is very important to reduce the amount of bleeding with a gauze packing. Furthermore, the time required for packing is fairly short, so that the patient is carefully monitored in a intensive care unit for hypothermia, acidosis and coagulopathy as soon as possible. Once the patient’s general condition is improved, trauma surgeons can plan for the re-operation. Packing is the most effective method than any other hemostatic maneuvers for a high-grad liver injury in particular. Complications caused by abdominal packing, such as intraabdominal sepsis, could be minimized by a removal of packing within 3 days. Currently, to control the major pelvic bleeding, preperitoneal packing is preferred than intraperitoneal method. Moreover, it can maximize an effective bleeding control, if both packing and angioembolization (pre- or post-operative) are applied complementarily. To facilitate the application of packing, trauma surgeons should understand the concept of ’damage control surgery’ including open abdominal techniques and optimize the patient’s general condition through an aggressive critical care.