MASSIVE PELVIC HEMORRHAGE DURING GYNECOLOGIC CANCER-SURGERY - PACK AND GO BACK

Over a 13-year period, intraabdominal packing has been used to control massive hemorrhage during surgery for gynecologic malignancy in six p atients, Fire patients had undergone total pelvic exenteration and one total abdominal hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer. Massive hemorrhage was defined as infusion of mor e than 10 units of blood and replacement of more than one total blood volume. Tamponade was performed using continuous Kerlex rolls (Kendall Co., Boston, MA) in a bowel bag with directed pressure over the hemor rhaging site with abdominal closure. The packs were removed in 48 to 7 2 hr in the operating room, transabdominally in five patients and tran svaginally in one. One postoperative death occurred within 8 hr of sur gery. The packing was ultimately successful in the five remaining pati ents. La five of six patients, tumors were removed before the packing, whereas in one, the tumor was removed concurrently with the pack. In one patient, immediate repacking was required after pack removal, with ultimate hemostasis. Morbidity included ''empty pelvis syndrome'' in four patients, neuropathy in three (obturator in 1, sciatic in 2), and small bowel obstruction in one. In patients with severe intraoperativ e hemorrhage, intraabdominal packing has been succesful as a mode of t reatment. (C) 1996 Academic Press, Inc.