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Erschienen in: World Journal of Surgery 4/2021

16.01.2021 | Original Scientific Report

Intra-Abdominal Hemorrhage Control: The Need for Routine Four-Quadrant Packing Explored

verfasst von: Dominik A. Jakob, Panagiotis Liasidis, Morgan Schellenberg, Kazuhide Matsushima, Lydia Lam, Demetrios Demetriades, Kenji Inaba

Erschienen in: World Journal of Surgery | Ausgabe 4/2021

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Abstract

Background

Routine four-quadrant packing (4QP) for hemorrhage control immediately upon opening is a standard practice for acute trauma laparotomy. The aim of this study was to evaluate the utility of 4QP for bleeding control in acutely injured patients undergoing trauma laparotomy.

Methods

Retrospective single-center study (01/2015–07/2019), including adult patients who underwent trauma laparotomy within 4 h of admission. Only patients with active intra-abdominal hemorrhage, defined as bleeding within the peritoneal cavity or expanding retroperitoneal hematoma, were considered for analysis. Bleeding sources were categorized anatomically: liver/retrohepatic inferior vena cava (RIVC), spleen, retroperitoneal zones 1, 2 and 3, mesentery and others. Hemorrhage was further categorized as originating from a single bleeding site (SBS) or from multiple bleeding sites (MBS). The effectiveness of directed versus 4QP was evaluated for bleeding from the liver/RIVC, spleen and retroperitoneal zone 3, areas that are potentially compressible. Directed packing was defined as indicated if the bleeding was restricted to one of the anatomic sites suitable for packing, 4QP was defined as indicated if ≥ 2 of the anatomic sites suitable for packing were bleeding.

Results

During the study time frame, 924 patients underwent trauma laparotomy, of which 148 (16%) had active intra-abdominal hemorrhage. Of these, 47% had a SBS and 53% had MBS. The liver/RIVC was the most common bleeding source in both patients with SBS (42%) and in patients with MBS (54%). According to our predefined indications, 22 of 148 patients (15%) would have benefitted from initial 4QP, 90 of 148 patients (61%) from directed packing and 36 of 148 patients (24%) packing would not have been of any value.

Conclusion

Routine four-quadrant packing is frequently practiced. However, this is only required in a small proportion of patients undergoing trauma laparotomy. Directed packing can be equally effective, saves time and decreases the risk of iatrogenic injury from unnecessary packing.
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Metadaten
Titel
Intra-Abdominal Hemorrhage Control: The Need for Routine Four-Quadrant Packing Explored
verfasst von
Dominik A. Jakob
Panagiotis Liasidis
Morgan Schellenberg
Kazuhide Matsushima
Lydia Lam
Demetrios Demetriades
Kenji Inaba
Publikationsdatum
16.01.2021
Verlag
Springer International Publishing
Erschienen in
World Journal of Surgery / Ausgabe 4/2021
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-020-05906-3

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