J Korean Soc Traumatol.  2017 Dec;30(4):238-241. 10.20408/jti.2017.30.4.238.

Internal Iliac Artery Ligation with Pad Packing for Hemodynamic Unstable Open Comminuted Sacral Fracture

• Kim SK
• Park YC
• Jo YG
• Kang WS
• Kim JC

• KMID: 2405294
• DOI: http://doi.org/10.20408/jti.2017.30.4.238

Abstract

A 52-year-old man experienced blunt trauma upon falling from a height of 40 m while trying to repair the elevator. The patient's systolic blood pressure and hemoglobin levels were 60 mmHg and 7.0 g/dL, respectively, upon admission. A large volume of bloody discharge was observed in the open wound of the perianal area and sacrum. A computed tomography scan revealed an open comminuted sacral fracture with multiple contrast blushes. He underwent emergency laparotomy. Both internal iliac artery ligations were performed to control bleeding from the pelvis. Protective sigmoid loop colostomy was performed because of massive injury to the anal sphincters and pelvis. Pad packing was performed for a sacral open wound and perineal wound at the prone position. After resuscitation of massive transfusion, he underwent the second operation 2 days after the first operation. The pad was removed and the perineal and sacral open wounds were closed. After the damage-control surgery, he recovered safely. In this case, the hemodynamically unstable, open comminuted sacral fracture was treated safely by internal iliac artery ligation with pad packing.

Keyword

Pelvic bone; Injuries; Hemorrhage; Iliac artery

MeSH Terms

Accidental Falls
Anal Canal
Blood Pressure
Colon, Sigmoid
Colostomy
Elevators and Escalators
Emergencies
Hemodynamics*
Hemorrhage
Humans
Iliac Artery*
Laparotomy
Ligation*
Middle Aged
Pelvic Bones
Pelvis
Prone Position
Resuscitation
Sacrum
Wounds and Injuries