RESUMO
Hysterectomy is the ultimate management option for uterine hemorrhage.If other less invasive methods are unable to control the life-threatening uterine bleeding in the management of amniotic fluid embolism,hysterectomy should be immediately performed.However,hysterectomy is not the primary ornecessary treatment in most cases and prophylactic hysterectomy should never be performed.The indications,techniques and perioperative management are discussed in the article.
RESUMO
Inferior venacaval compression is a common problem in late pregnancy. It can also occur due to compression of inferior venacava by abdominal or pelvic tumors. We report a case of acute iatrogenic inferior venacaval compression due to excessive abdominal packing during an intraabdominal surgery.
Compressão da veia cava inferior é um problema comum no fim da gravidez. Também pode ocorrer por causa da compressão da veia cava inferior por tumores abdominais ou pélvicos. Relatamos um caso de compressão iatrogênica aguda da veia cava inferior por causa do excesso de tamponamento durante uma cirurgia intra-abdominal.
La compresión de la vena cava inferior es un problema común al final del embarazo. También puede ocurrir debido a la compresión de la vena cava inferior por tumores abdominales o pélvicos. Relatamos un caso de compresión iatrogénica aguda de la vena cava inferior debido al exceso de taponamiento durante una cirugía intraabdominal.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Abdome/cirurgia , Veia Cava Inferior/patologiaRESUMO
Background: Using abdominal packs is often a life-saving technique for uncontrollable bleeding during operations. It prevents worsening of the hypothermia, coagulopathy and acidosis which usually accompanies massive bleeding till they may be corrected and the packs removed later. However, packing may be associated with a mortality of 56 to 82 % due to continued bleeding, intra-abdominal abscesses and the compartment syndrome. We follow a policy of early abdominal packing (considering it after a 6 unit intraoperative blood loss) before the situation becomes irreversible. Patients and methods: Between January 1997 and September 2008, abdominal packing for uncontrollable bleed was done in 49 patients (M:F 34:15, mean age 43 years) . The risk factors for mortality were analyzed. The reasons for uncontrollable bleed were : liver trauma (8), liver tumours (3), following liver transplantation (4), pancreatic necrosectomy (17) and miscellaneous causes (17). Results: There were 16 postoperative deaths (32.7%). On univariate analysis, hypovolaemic shock, a low urine output, raised INR, blood requirement of more than 6 units, hypothermia <340C, metabolic acidosis and sepsis were associated with an increased mortality. However, on multivariate logistic regression only hypothermia was significantly associated with mortality. Conclusion: A fair survival rate can be achieved by early and judicious use of abdominal packing especially before hypothermia supervenes.
RESUMO
OBJECTIVE To determine the prevalence of post-operative infections in patients who underwent damage control laparotomy(DCL) with abdominal packing and to identify the risk factors,mortality and predominant pathogens.METHODS A retrospective study of postoperative infections and microbiology in patients who underwent abdominal packing as an adjunct of DCL to control coagulopathic hemorrhage over a 5 year period(Feb 2002-Feb 2007) were performed.RESULTS A total of 26 patients were studied.Pneumonia/lower respivatory tract infection was the prominant type of infection(57.7%),followed by bacteremia(50.0%),urinary tract infection(15.4%) and wound infection(15.4%).Of the 244 organisms isolated from various sites,the most frequently isolated bacteria were Pseudomonas aeruginosa(27.0%),Staphylococcus species(15.6%),Acinetobacter baumannii(13.9%),and Klebsiella species(11.1%).No statistical correlation was found between positive packs and postoperative infection(P=0.10) or death(P=1.00).Multivariate regression analysis revealed that pre-existing abdominal infection(OR=22.4,P=0.02) and increased number of surgical procedures(OR=3.69,P=0.05) were the independent risk factors for post-operative infections.CONCLUSIONS Patients who undergo DCL with packing have a high incidence of postoperative infections.Pathogens and distribution are same as acquired infections.Pre-existing abdominal infection and increased number of surgical procedures are the independent risk factors for postoperative infections in these patients.