Summary
From 1984 to 1991 20 multiple trauma patients with pelvic fractures and retroperitoneal bleeding from pelvic vessels underwent angiographic localization and embolization of massively bleeding arterial vessels. Nine patients survived (multiple trauma index grade III, Hanover polytrauma index), three patients with very severe injuries died immediately (multiple trauma index grade IV). After successful control of bleeding by embolization, three other patients died from severe brain injuries and five patients from septic multiorgan failure. The interval to definite localization and treatment of the bleeding source was three times shorter in the group of survivors, and the amount of transfusions needed was less by a factor of three. This underlines the importance of early angiography in multiple trauma patients with pelvic fractures and persisting hemorrhage. Embolization has proven to be effective in the treatment of such injuries.
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Ayella RJ, DuPriest RW, Khaneya SC, Maekawa T (1978) Transcatheter embolization of autologous clot in the management of bleeding associated with fractures of the pelvis. J Surg Gynecol Obstet 147:849–852
Belgerden S, Kurtoglu M, Basar Y, Aren A (1986) Laparotomieindikationen bei Beckenbrüchen. Zentralbl Chir 111:605–608
Ben-Menachem Y (1986) Massive blunt trauma: radiologic diagnosis and intervention. Instr Course Lect 35:31–35
Ben-Menachem Y (1988) Pelvic fractures: diagnostic and therapeutic angiography. Instr Course Lect 37:139–141
Bucknam CA (1984) Vascular complications of fractures and dislocations. In: Gossling HR, Pillsburg SL (eds) Complications of fracture management. Lippincott, Philadelphia, pp 123–140
Cryer HM, Miller FB, Evers M (1989) Pelvic fracture classification: correlation with hemorrhage. J Trauma 29:981–992
Dalal SA, Burgess AR, Siegel JH, Young JW (1989) Pelvic fracture in multiple trauma: classification by mechanism is key to pattern of organ injury, resuscitative requirements and outcome. J Trauma 29:993–1002
Delany HM, Jason RS (1988) Abdominal trauma. Springer, New York Berlin Heidelberg
Gilliland MG, Ward RE, Flynn TC, Miller PW (1983) Peritoneal lavage and angiography in the management of patients with pelvic fractures. Am J Surg 144:744–762
Hubbard SG, Bivins SG, Sachatello CR (1986) Diagnostic errors with peritoneal lavage in patients with pelvic fractures. J Trauma 26:987–994
Jender HP, Russinovich NAE (1980) Transcatheter gelfoam embolization in abdominal, retroperitoneal and pelvic hemorrhage. Radiology 136:337–344
Mansour MA, Moore FA, Moore EE (1989) Hypogastric arterial embolization in pelvic fractures. J Trauma 29:1417–1425
Moreno C, Moore EE, Rosenberger A, Cleeveland HC (1986) Hemorrhage associated with major pelvic fracture: a multispeciality challenge. J Trauma 26:987–994
Oestern HJ, Tscherne H, Sturm J, Nerlich M (1985) Klassifizierung der Verletzungsschwere. Unfallchirurg 88:465–472
Panetta T, Sclafani S, Goldstein AS (1985) Percutaneous transcatheter embolization for massive bleeding from pelvic fractures. J Trauma 25:1021–1029
Selivanov V, Sang CH, Alverdy JC, Morris JA, Sheldon GF (1984) Mortality in retroperitoneal hematoma. J Trauma 24:1022–1027
Sheldon GF, Winestock DP (1978) Hemorrhage from open pelvic fracture controlled intraoperatively with ballon catheter. J Trauma 18:68–70
Tile M (1988) Pelvic ring fractures: should they be fixed? J Bone Joint Surg [Br] 70:1–12
Young JWR, Burgess AR, Brumbach RJ, Poka Attila R (1986) Pelvic fractures: value of plain radiography in early assessments and management. Radiology 160:445–451
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Hölting, T., Buhr, H.J., Richter, G.M. et al. Diagnosis and treatment of retroperitoneal hematoma in multiple trauma patients. Arch Orthop Trauma Surg 111, 323–326 (1992). https://doi.org/10.1007/BF00420059
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DOI: https://doi.org/10.1007/BF00420059