Surgical pelvic packing as a means of controlling massive intraoperative bleeding during pelvic posterior exenteration - a case report and review of the literature

Abstract

This is a report of a case of gynecological hemorrhage after a posterior pelvic exenteration in patients with vulvar cancer treated by temporary pelvic packing at the Department of Gynecology of the Medical University in Gdańsk. The packing was successful and the sponges were removed after 24 h. Twenty-eight days after the operation, the patient was transferred to the Department of Radiotherapy for supplementary treatment. In patients with severe intraoperative hemorrhage, intra-abdominal packing has been successful as a mode of treatment.

Extraperitoneal Pelvic Packing: A Salvage Procedure to Control Massive Traumatic Pelvic Hemorrhage

“…13 Today, several different techniques of pelvic packing are used, 14,15 but very little has been published on the effect of pelvic packing on bleeding control. In 1994 the senior author (O.R.)…”

The Control of Haemostasis of Presacral Venous Haemorrhage with Sterile Thumbtacks and Roller Gauze—Experience in Managing a Case of Recurrent Ovarian Cancer

“…Presacral fascia is a protective layer on top interlinking thinwalled venous plexus that lines the periosteum of the sacral bone (Wydra et al, 2004). Presacral fascia is minimally vascular, hence, the haemostasis is usually easy to control; however, should there be dissection deeper and away from this fascia, the presacral venous plexus would be injured and bleeding would be torrential.…”

“…In 1926, Logothetopulos first described in full extent the ways of pelvic packing for massive haemorrhage with gauge. His technique was further improvised by Parente in 1962, by replacing the gauge veil with polyethylene sheet for packing to achieve less adhesions and to facilitate the removal of the pelvic pack during reexploration (Wydra et al, 2004).…”

Development and Clinical Implementation of a Hemostatic Balloon Device for Rectal Cancer Surgery

“…13,14 One commonly used technique in massive bleeding from the presacral venous plexus is packing the pelvis with surgical gauzes, which achieves hemostasis by applying uncontrolled pressure on the pelvic cavity wall. [15][16][17] An important advantage of packing with gauzes is the ability to fill up different shaped cavities. However, a big disadvantage of the surgical gauze is the adherence to the surrounding tissues.…”