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J Trauma Inj > Volume 30(1); 2017 > Article
Journal of Trauma and Injury 2017;30(1):12-15.
DOI: https://doi.org/10.20408/jti.2017.30.1.12    Published online March 31, 2017.
Temporary Closure for Sternotomy in Patient with Massive Transfusion Might Be Lethal
Maru Kim, Joongsuck Kim, Sung Jeep Kim, Hang Joo Cho
Department of Trauma Surgery, Uijeongbu St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Korea. surgeryman@catholic.ac.kr
Received: 11 August 2016   • Revised: 16 August 2016   • Accepted: 28 September 2016
Abstract
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.
Key Words: Hemorrhage; Disseminated intravascular coagulation; Mortality; Multiple trauma; Sternotomy
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