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KMID : 0360720170300010012
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Journal of the Korean Society Traumatology
2017 Volume.30 No. 1 p.12 ~ p.15
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Temporary Closure for Sternotomy in Patient with Massive Transfusion Might Be Lethal
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Kim Ma-Ru
Kim Joong-Suck
Kim Sung-Jeep
Cho Hang-Joo
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Abstract
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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.
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KEYWORD
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Hemorrhage, Disseminated intravascular coagulation, Mortality, Multiple trauma, Sternotomy
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