Management of the major coagulopathy with onset during laparotomy

H. H. Stone, P. R. Strom, R. J. Mullins

    Research output: Contribution to journalArticle

    431 Scopus citations

    Abstract

    An experience with 31 patients who developed major bleeding diatheses during laparotomy was reviewed. Management of the initial 14 patients was by standard hematologic replacement, completion of all facets of operation, and then closure of the peritoneal cavity, usually with suction drainage; only one patient survived. The subsequent 17 patients had laparotomy terminated as rapidly as possible to avoid additional bleeding. Major vessel injuries were repaired; ends of resected bowel were ligated; and holes in other gastrointestinal segments and the bladder were closed by purse-string sutures. One patient had a ureter ligated. Laparotomy pads (4-17) were then packed within the abdomen to effect tamponade, and the abdomen was closed under tension without drains or stomata. Following correction of the coagulopathy, the abdomen was re-explored at 15 to 19 hours in the 12 survivors. Definitive surgery then was completed: bowel resection and reanastomosis; ureter reimplantation; drains for bile, pancreatic juice, and urine; and stomata for bowel or urine diversion or decompression. Eleven of 17 patients, deemed to have a lethal coagulopathy, survived. This technique of initial abortion of laparotomy, establishment of intra-abdominal pack tamponade, and then completion of the surgical procedure once coagulation has returned to an acceptable level has proven to be lifesaving in previously non-salvageable situations.

    Original languageEnglish (US)
    Pages (from-to)532-535
    Number of pages4
    JournalAnnals of surgery
    Volume197
    Issue number5
    DOIs
    StatePublished - Jan 1 1983

    ASJC Scopus subject areas

    • Surgery

    Fingerprint Dive into the research topics of 'Management of the major coagulopathy with onset during laparotomy'. Together they form a unique fingerprint.

  • Cite this