J Korean Soc Traumatol.  2017 Mar;30(1):12-15. 10.20408/jti.2017.30.1.12.

Temporary Closure for Sternotomy in Patient with Massive Transfusion Might Be Lethal

• Kim M
• Kim J
• Kim SJ
• Cho HJ

• KMID: 2379924
• DOI: http://doi.org/10.20408/jti.2017.30.1.12

Abstract

A 58-year-old male visited our emergency room for multiple traumas from explosion. On initial evaluation, hemopneumoperitoneum with liver laceration (grade 4) and colon perforation was identified. Hemopericardium with cardiac tamponade was also identified. Shrapnel was detected in the right ventricle. Damage control surgery was planned due to condition of hypotension. In operation room, control over bleeding was achieved after sternotomy, pericardiotomy, and laparotomy. Massive transfusion was done during operation. After gauze packing, operation was terminated with temporary closure (TC). Sanguineous fluid was drained profusely. Disseminated intravascular coagulopathy was confirmed through laboratory findings. No extravasation was discovered at hepatic angiogram. On re-operation, there was no active bleeding but oozing from sternotomy site was identified. Bone bleeding was impossible to control. Finally, reoperation was ended after gauze packing and TC all over again. The patient could survive for only a day after re-operation.

Keyword

Hemorrhage; Disseminated intravascular coagulation; Mortality; Multiple trauma; Sternotomy

MeSH Terms

Cardiac Tamponade
Colon
Disseminated Intravascular Coagulation
Emergency Service, Hospital
Explosions
Heart Ventricles
Hemorrhage
Humans
Hypotension
Lacerations
Laparotomy
Liver
Male
Middle Aged
Mortality
Multiple Trauma
Pericardial Effusion
Pericardiectomy
Reoperation
Sternotomy*