Management of the major coagulopathy with onset during laparotomy

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

Research output: Contribution to journalArticle

415 Citations (Scopus)

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
StatePublished - 1983
Externally publishedYes

Fingerprint

Laparotomy
Abdomen
Ureter
Urine
Hemorrhage
Pancreatic Juice
Induced Abortion
Replantation
Disease Susceptibility
Peritoneal Cavity
Suction
Decompression
Bile
Sutures
Survivors
Urinary Bladder
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery

Cite this

Management of the major coagulopathy with onset during laparotomy. / Stone, H. H.; Strom, P. R.; Mullins, Richard.

In: Annals of Surgery, Vol. 197, No. 5, 1983, p. 532-535.

Research output: Contribution to journalArticle

Stone, H. H. ; Strom, P. R. ; Mullins, Richard. / Management of the major coagulopathy with onset during laparotomy. In: Annals of Surgery. 1983 ; Vol. 197, No. 5. pp. 532-535.
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