Managing uncontrolled bleeding in elective surgery: The role of damage control techniques

七島, 篤志; ナナシマ, アツシ; Nanashima, Atsushi; 和田, 敬; ワダ, タカシ; Wada, Takashi; 河野, 文彰; カワノ, フミアキ; Kawano, Fumiaki; Hamada, Kiyoaki; Taniguchi, Tomoaki; 古川, 貢之; フルカワ, コウジ; Furukawa, Koji

doi:https://doi.org/10.1016/j.ijscr.2025.111040

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Managing uncontrolled bleeding in elective surgery: The role of damage control techniques

http://hdl.handle.net/10458/0002001245

名前 / ファイル	ライセンス	アクション
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学術雑誌論文 / Journal Article(1)

公開日

2025-05-01

タイトル

Managing uncontrolled bleeding in elective surgery: The role of damage control techniques

言語

eng

キーワード

言語

キーワード

Abdominal surgery

キーワード

言語

キーワード

Damage control surgery

キーワード

言語

キーワード

Second look operation

キーワード

言語

キーワード

Uncontrolled bleeding

資源タイプ

journal article

アクセス権

open access

著者

七島, 篤志

WEKO 33886
e-Rad_Researcher 60380838

ja	七島, 篤志宮崎大学
ja-Kana	ナナシマ, アツシ
en	Nanashima, Atsushi University of Miyazaki

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和田, 敬

WEKO 35523
e-Rad_Researcher 30783980

ja	和田, 敬宮崎大学
ja-Kana	ワダ, タカシ
en	Wada, Takashi University of Miyazaki

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河野, 文彰

WEKO 34859
e-Rad_Researcher 20511215

ja	河野, 文彰宮崎大学
ja-Kana	カワノ, フミアキ
en	Kawano, Fumiaki University of Miyazaki

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Hamada, Kiyoaki
Taniguchi, Tomoaki
古川, 貢之

WEKO 34654
e-Rad_Researcher 40404446

ja	古川, 貢之宮崎大学
ja-Kana	フルカワ, コウジ
en	Furukawa, Koji University of Miyazaki

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Abstract

内容記述

Introduction
The main text introduction expands on the initial introduction by providing a more detailed discussion of massive bleeding in elective surgeries and its challenges. It describes how traditional hemostatic procedures are essential but may not always be sufficient, especially in uncontrolled coagulopathy despite aggressive transfusion. It then introduces DCS as a well-established approach in trauma surgery, emphasizing its role in stabilizing patients with hemorrhagic shock, coagulopathy, hypothermia, and acidosis. It highlights that DCS can be a lifesaving intervention when unexpected massive bleeding occurs and justifies its use in patients with unstable vital signs or increased intra-abdominal pressure by our two experienced cases presentation.
Case 1. A 76-year-old obese male diagnosed with advanced transverse colon cancer with regional balky lymph node metastasis was identified at the root of the regional colic vein trunk. A robotic surgical approach was changed to open laparotomy because of bleeding tendency due to fatty mesentery. During the balky node dissection, the root of the vein was injured and induced massive bleeding during the compressive hemostatic procedure. As the hypotensive control rapidly became quite tricky, DCS by gauze packing and covered by the commercial dressing kit with open abdominal management (OAM). The second look operation, by supporting the Restrictive Endovascular Balloon Occlusion of the Aorta, repaired the superior mesenteric vein's injured parts. He survived for nine months.
Case 2. The 72-year-old male patient was diagnosed as solitary 3 cm of hepatocellular carcinoma at S6 with alcoholic liver cirrhosis. The laparoscopic limited hepatic resection was changed to the open laparotomy due to the bleeding tendency at the transected parenchyma. After accomplishing limited resection, massive hepatic venous bleeding occurred; DCS was decided due to continuing hypotension, oozed hemorrhage, and low platelet level with metabolic acidosis by peri-hepatic gauze packing around the right liver. The second look operation for remnant hemostasis and the de-packing with abdominal closure could be achieved without severe events. The postoperative course showed no hepatic failure, and they recovered during a hospital stay.
Discussion
It describes how conventional hemostatic procedures are essential but may not always be sufficient, especially in uncontrolled coagulopathy despite aggressive transfusion. DCS is a well-established approach in trauma surgery, emphasizing its role in stabilizing patients with hemorrhagic shock, coagulopathy, hypothermia, and acidosis. The role of DCS is well known even in elective surgery in unforeseen emergency situations such as hemodynamic instability, severe coagulopathy, and prolonged surgery over 24 h. It highlights that DCS can be a lifesaving intervention when unexpected massive bleeding occurs and justifies its use in patients with unstable vital signs or increased intra-abdominal pressure, where prolonged surgery is not feasible. It reinforces that DCS was successfully utilized in the reported cases, leading to favorable second-look operations.
Conclusion
The main text introduction is a more comprehensive and structured expansion of the initial introduction. While the initial version introduces the problem concisely, the revised introduction elaborates on the challenges of massive bleeding, the principles of DCS, and its potential role in elective surgeries before transitioning into the case reports.

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内容記述

Citation: Atsushi Nanashima, Takashi Wada, Fumiaki Kawano, Kiyoaki Hamada, Tomoaki Taniguchi, Koji Furukawa, Managing uncontrolled bleeding in elective surgery: The role of damage control techniques, International Journal of Surgery Case Reports, 128, 111040-111040, 2025-03, https://doi.org/10.1016/j.ijscr.2025.111040

言語

bibliographic_information

en : International Journal of Surgery Case Reports

巻 128, p. 111040, 発行日 2025-03

出版者

Elsevier BV

言語

ISSN

収録物識別子タイプ

EISSN

収録物識別子

2210-2612

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2025-05-01 00:52:43.804311

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