Surgical Hemorrhage, Damage Control, and the Abdominal Compartment Syndrome

ABSTRACT

The morbidity and mortality associated with surgical hemorrhage are considerable, particularly when relaparotomy is necessary. This complication can usually be avoided with comprehensive preoperative patient evaluation and meticulous surgical technique. The damage control sequence is a useful surgical strategy when severe intraoperative coagulopathy or hemodynamic instability is present. Abdominal compartment syndrome is a potentially lethal phenomenon that can occur following laparotomy or large-volume fluid resuscitation, or both. Early recognition and intervention are critical to survival of the patient when this syndrome occurs.

KEYWORDS

Surgical hemorrhage - damage control - abdominal compartment syndrome

REFERENCES

• 1 Martlew V J. Peri-operative management of patients with coagulation disorders.  Br J Anaesth. 2000;  85 446-455
• 2 Streiff M B. Abnormal operative and postoperative bleeding. In Cameron JL Current Surgical Therapy. 8th ed. St. Louis, MO; Mosby 2004: 1122-1135
• 3 Weaver D W. Differential diagnosis and management of unexplained bleeding.  Surg Clin North Am. 1993;  73 353-361
• 4 Jaffer A K, Ahmed M, Brotman D J et al.. Low-molecular-weight-heparins as periprocedural anticoagulation for patients on long-term warfarin therapy: a standardized bridging therapy protocol.  J Thromb Thrombolysis. 2005;  20 11-16
• 5 Hill A DK, Menzies-Gow N, Darzi A. Methods of controlling presacral bleeding.  J Am Coll Surg. 1994;  178 183-184
• 6 Wang Q Y, Shi W J, Zhao Y R, Zhou W Q, He Z R. New concepts in severe presacral hemorrhage during proctectomy.  Arch Surg. 1985;  120 1013-1020
• 7 Nivatvongs S, Fang D T. The use of thumbtacks to stop massive presacral hemorrhage.  Dis Colon Rectum. 1986;  29 589-590
• 8 van der Vurst T J, Bodegom M E, Rakic S. Tamponade of presacral hemorrhage with hemostatic sponges fixed to the sacrum with endoscopic helical tackers: report of two cases.  Dis Colon Rectum. 2004;  47 1550-1553
• 9 Braley S C, Schneider P D, Bold R J, Goodnight J E, Khatri V P. Controlled tamponade of severe presacral venous hemorrhage.  Dis Colon Rectum. 2002;  45 140-142
• 10 Losanoff J E, Richman B W, Jones J W. Cyanoacrylate adhesive in management of severe presacral bleeding.  Dis Colon Rectum. 2002;  45 1118-1119
• 11 Remzi F H, Oncel M, Fazio V W. Muscle tamponade to control presacral venous bleeding: report of two cases.  Dis Colon Rectum. 2002;  45 1109-1111
• 12 Harrison J L, Hooks V H, Pearl R K et al.. Muscle fragment welding for control of massive presacral bleeding during rectal mobilization: a review of eight cases.  Dis Colon Rectum. 2003;  46 1115-1117
• 13 Ayuste Jr E, Roxas M FT. Validating the use of rectus muscle fragment welding to control presacral bleeding during rectal mobilization.  Asian J Surg. 2004;  27 18-21
• 14 Stone H H, Strom P R, Mullins R J. Management of the major coagulopathy with onset during laparotomy.  Ann Surg. 1983;  197 532-535
• 15 Shapiro M B, Jenkins D H, Schwab W, Rotondo M F. Damage control: collective review.  J Trauma. 2000;  49 969-978
• 16 Moise K J, Belfort M A. Damage control for the obstetric patient.  Surg Clin North Am. 1997;  77 835-852
• 17 Coburn M. Damage control for urologic injuries.  Surg Clin North Am. 1997;  77 821-834
• 18 McPartland K J, Hyman N H. Damage control: what is its role in colorectal surgery?.  Dis Colon Rectum. 2003;  46 981-986
• 19 Rotondo M F, Zonies D H. The damage control sequence and underlying logic.  Surg Clin North Am. 1997;  77 761-777
• 20 Rutherford E J, Skeete D A, Brasel K J. Management of the patient with an open abdomen: techniques in temporary and definitive closure.  Curr Probl Surg. 2004;  41 815-876
• 21 Miller P R, Meredith J W, Johnson J C, Chang M C. Prospective evaluation of vacuum-assisted fascial closure after open abdomen: planned ventral hernia rate is substantially reduced.  Ann Surg. 2004;  239 608-616
• 22 Rotondo M F, Schwab C W, Mcgonigal M D et al.. Damage control: an approach for improved survival in exsanguinating penetrating abdominal injury.  J Trauma. 1993;  35 375-383
• 23 Sharp K W, Locicero R J. Abdominal packing for surgically uncontrollable hemorrhage.  Ann Surg. 1992;  215 467-475
• 24 Burch J M, Ortiz V B, Richardson R J, Martin R R, Mattox K L, Jordan Jr G L. Abbreviated laparotomy and planned reoperation for critically injured patients.  Ann Surg. 1992;  215 476-484
• 25 Hirshberg A, Wall M J, Ramchandani M K, Mattox K L. Reoperation for bleeding in trauma.  Arch Surg. 1993;  128 1163-1167
• 26 Moore G E, Payne M J. Intra-abdominal hemorrhage following abdominal surgery.  AMA Arch Surg. 1958;  77 162-164
• 27 Cappell M S, Ghandi D, Huh C. A study of the safety and clinical efficacy of flexible sigmoidoscopy and colonoscopy after recent colonic surgery in 52 patients.  Am J Gastroenterol. 1995;  90 1130-1134
• 28 Hirshberg A, Stein M, Adar R. Reoperation: planned and unplanned.  Surg Clin North Am. 1997;  77 897-907
• 29 Harbrecht P J, Garrison N, Fry D E. Early urgent relaparotomy.  Arch Surg. 1984;  119 369-374
• 30 Bunt T J. Urgent relaparotomy: the high-risk, no-choice operation.  Surgery. 1985;  98 555-560
• 31 Zer M, Dux S, Dintsman M. The timing of relaparotomy and its influence on prognosis: a 10 year survey.  Am J Surg. 1980;  139 338-343
• 32 Krause R. Reintervention in abdominal surgery.  World J Surg. 1987;  11 226-232
• 33 Schein M, Wittmann D H, Aprahamian C C, Condon R E. The abdominal compartment syndrome: the physiological and clinical consequences of elevated intra-abdominal pressure.  J Am Coll Surg. 1995;  180 745-753
• 34 Maxwell R A, Fabian T C, Croce M A, Davis K A. Secondary abdominal compartment syndrome: an underappreciated manifestation of severe hemorrhagic shock.  J Trauma. 1999;  47 995-999
• 35 Tal R, Lask D M, Keslin J, Livne P M. Abdominal compartment syndrome: urological aspects.  BJU Int. 2004;  93 474-477
• 36 Sugrue M. Abdominal compartment syndrome.  Curr Opin Crit Care. 2005;  11 333-338
• 37 Ivatury R R, Diebel L, Porter J M, Simon R J. Intra-abdominal hypertension and the abdominal compartment syndrome.  Surg Clin North Am. 1997;  77 783-800
• 38 Simon R J, Friedlander M H, Ivatury R R, DiRaimo R, Machiedo G W. Hemorrhage lowers the threshold for intra-abdominal hypertension-induced pulmonary dysfunction.  J Trauma. 1997;  42 398-405
• 39 Moore-Olufemi S D, Xue H, Allen S J et al.. Effects of primary and secondary intra-abdominal hypertension on mesenteric lymph flow: implications for the abdominal compartment syndrome.  Shock. 2005;  23 571-575
• 40 Eddy V, Nunn C, Morris Jr J A. Abdominal compartment syndrome: the Nashville experience.  Surg Clin North Am. 1997;  77 801-812
• 41 Balogh Z, McKinley B A, Holcomb J B et al.. Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure.  J Trauma. 2003;  54 848-861
• 42 Meldrum D R, Moore F A, Moore E E, Franciose R J, Sauaia A, Burch J M. Prospective characterization and selective management of the abdominal compartment syndrome.  Am J Surg. 1997;  174 667-672
• 43 Jernigan T W, Fabian T C, Croce M A et al.. Staged management of giant abdominal wall defects: acute and long-term results.  Ann Surg. 2003;  238 349-357