[Arterial embolisation for post-traumatic retroperitoneal bleeding].

Abstract

Background: Road traffic accidents resulting in multiple organ trauma are among the leading causes of mortality among people under 45 years of age. Those with pelvic injury are at special risk, because of difficult haemostasis and massive bleeding of mixed origin. Various methods of treatment have been used, including laparotomy, direct clamping and ligation of affected vessels, retroperitoneal packing, and external/internal pelvic stabilisation. In selected cases, angioembolisation of various vessels can be used

Case reports: A 24-year-old male patient was admitted after a road traffic accident, in which he suffered multiple injuries to the skull, abdomen and pelvis. An emergency laparotomy was performed, revealing ruptures of the spleen, mesentery, right ureter, and bladder, and a giant haematoma in the retroperitoneal space. The spleen was removed, and the traumatised organs temporarily repaired. The pelvis and femoral bones were stabilised externally. After surgery, the patient was transferred to the ITU; he was haemodynamically unstable due to coagulopathy and persistent bleeding from the superior gluteal artery. On the fourth day, angioembolisation of the latter was performed using three occluding coils that resulted in immediate control of the bleeding and haemodynamic stabilisation.

Discussion and conclusion: In selected cases of severe bleeding from a traumatic pelvic injury, angioembolisation can be used as a lifesaving technique, especially in patients with coagulopathy after ineffective surgical interventions.